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STATE OF CALIFORNIA �,7p NT OF PESTICIDE REGULATION PESTICIDE EPISODE INVESTIGATION REPORT CV ESTICIDE ENFORCEMENT BRANCH PR-ENF-127(EST/ 10/91)(REV. SJC 1/96) Pagel of RECEIVED BY RECEIVED FROM REPRESENTING DATFTR RRECEIVED ERSON NOTIFIED DATE San Joaquin Co.Ag.Com. Jim Shattuck CDPR 8/21/15/8:43 AM DFA TYPE OF EPISODE ❑HUMAN EFFECTS# ®ENVIRONMENTAL EFFECTS PRIORITY INVESTIGATION DFG ❑PROPERTY LOSS ❑OTHER ❑YES#_ ONO DHS 9THER I.D.NO. COUNTY OF OCCURRENCE DATE OF OCCURRENCE TRrfE DIR 15-33 San Joaquin MO 8 DAY 21 YR 2015 12:02 AM EPA AUG 31 701 EPISODE LOCATION CAC L BNSF Stockton Mormon Rail Yard track 139. O PERMIT/SERVICES INSURED/COMPLAINANT INFORMATION COMPLAINT SIGNED DR.VISITED EXTENT OF INIIIRY/B.LNESS. ACTIVITY OF PERSON EXPOSED/INVOLVED ❑YES ❑NO ®N/A ❑YES ❑NO E N/A ❑Fatal ❑Symptoms ❑Mixer/Loader ❑Field Worker" ❑Other' Serious nExposedOnly n ADDlicator Public* *Ex Iain NAME AGE SEX VFRFii�:OES COA-lid WORKDAYS LOST Jim Shattuck N/A M 15-4899 0 ADDRESS CITY ZIP PHONE 10011 Street Sacramento 95812-2815 916-445.4729 MEDICAL FACILITY NAME ❑TREATMENT PROVIDED HOSPITALIZED DATE(H],1EADMITTED DATE IME DISCHARGED N/A ❑OBSERVATION ONLY ❑YES ®NO N/A N/A PHYSICIANADDRESS ��; `p[LONE N/A df18'.��A'�, SIGNS/SYMPTOMS EXPERIENCED None reported AUG 2 6 2015 EMPLOYER ADDRESS AGR. COMM:S-J'W I"E CDPR PROTECTIVE MEASURES USED EYES HANDS INHALATION OTHER ENGINEERING CONTROLS ❑Safety Glasses ❑Cloth/Leather Gloves ❑Dust Mask ®Work Clothes [:1 Goggles Ll Closed System ❑Chem.Resistant Gloves ❑12 Face Respirator Chem.Resistant Clothes El Enclosed Cab ❑Faceshield ❑Other_ ❑Full Face Respirator ❑Chem.Resistant Boots ❑Enc.Cab w/Air Purification ❑Eye/Sun Glasses ®None ❑SCBA ❑Head Covering E None ®None ❑Other Fl Other 621 Nunn ENVIRONMENTALOR PROPERTY DAMAGE DESCRIPTION OF DAMAGE AMOUNTNALUE Leakage of Metam Sodium from a rail car. N/A OWNER ADDRESS PHONE BNSF 720 South B St. Stockton CA 95206 209-460-6393 ALLEGED RESPONDENTS PCA DEALER PILOT 0 GROWER 0 AGENCY OTHER- NAME PHONE LICENSF/PERMIT NO. RECOMMENDATION MADE BNSF 209-460-6369 N/A ❑YES# ®NO ADDRESS EMPLOYER'S NAME PHONE 720 South B St. Same CITYSTATE zip EMPLOYER'S ADDRESS Stockton CA 95206 Same EXPLAIN* CITY STATE ZIP Leakage of Metam Sodium from a rail car PESTICIDE NAMEJMANUFACTURER EPA REGISTRATION NUMBER CATEGORY I DOSE/DR.UTIONNOLUME TREATMENT DATE COMMODITY/SITE TREATEI Secta on 42/Nova Source 61842-6 I N/A N/A N/A EQUIPMENT/MAKEMODELIDESCRIPTION Rail Car Number UTLX 200074 Summarize the episode including a detailed description of evidence taken(Use Pesticide Episode Investigation Supplemental Report if Additional Space is Needed) On August 21,2015 at 8:43 AM Jim Shattuck of CDPR informed the San Joaquin County Agricultural Commissioner's Office through email of a Hazardous Materials Spill Report(OES Control#:15-4899). Assistant Commissioner(AC)Kamal Bagri instructed me,Senior Agricultural Biologist Robert Pelletier,to contact the Environmental Health Department to offer our departments assistance. AC Bagri provided a contact name of Muniappa Naidu,Lead Senior Registered Environmental Health Specialist(EHS). AC Bagri then sent me a copy of Mr.Shattuck's email. The email stated a rail car(UTLX 200074)located in the Stockton Rail Yard on track 139 leaked approximately 5 gallons of Metam Sodium. "DESCRIPTION:A railyard mechanic observed a release of approximately 5 gallons of Metam Sodium coming from the top of a single tank car(UTLX 200074). The release was contained to the soil below the tank car and was identified as a slow drip from the tank car to the ground. The release is on-going. The location of the tank car is within the Stockton Railyard on track#139,mile post marker 1119.5. BNSF environmental and hazardous materials personnel are en-route to the scene." REPORT PREPARED BY(N DATE PREPARED REPORT REVIEWED/APPROVED BY(NAME(fITLE) DATE APPROVED Robert Pelletier/SAB 8/26/2015 Barbara Huecksteadt/DAC 8/26/2015