Laserfiche WebLink
C$- <br /> MOCK Ammonia Release Event Report <br /> Facility - Stockton Building - PDC <br /> Notification TypeInitial: ❑ Supplemental: ❑ Final: X Follow-up: ❑ <br /> Event Scribe: U Scribe Contacts; 209-479-9431 <br /> -. s - <br /> EVent'<RepOrting lnfOrmatlOn (Made to indvldual(s),gn emergency contact card(s)) <br /> Name of Facility Stockton PDC Physical Address: 4199 Gibraltar Court <br /> Local Contact Name Tracy Logistics Phone Number: 209-2344681 <br /> Date of Event 5/8/18 Time of Event: 10:30am <br /> Release is Ongoing Yes ❑ No X Active Alarm Yes X No ❑ <br /> Brief Description of Event 3rd Party vendor set off Amonia Sensor triggering alarm.All employees evacuated <br /> CrItlCal I�OteS , (No#e reieSant names,of individuals to details SQction) <br /> When did we become aware of the <br /> release? Date:5/8/18 Time:10:30am Details:No release false alarm <br /> Corporate or State/Federal Reporting <br /> Completed Date: . Time: Details:N/A <br /> 911 Call Completed Date: Time: Details:Fire Department notified false alarm <br /> HR Event Report to Public Information <br /> Officer(Bryan Granger"PIO") Date: Time: Details:N/A <br /> Media Re-directed to Plo Date: Time: Details:N/A <br /> Fire Department Arrival Date: Time: Details:Call Cancelled <br /> HazMat Team Arrival Date: Time: Details:N/A <br /> Incident Command Changeover Date: Time: Details:N/A <br /> Assembly Area Accounting Complete Date:5/8/18 Time: Details:all head count accounted for PDC <br /> Release Stopped Date: Time: Details:No release <br /> All Clear Given by Incident Command Date:5/8/18 Time:10:40am Details:Cleared by maint.At 30:39am <br /> Detailed Explanation of hncldent,Eyent <br /> 3rd Party vendor set off Amonia Sensor triggering alarm.All employees evacuated.Tony Rem gave ok to return false alarm at 10:39am <br /> Rev 1.0 <br /> Hard Copy—Put in Recordkeeping Binder in"Evac./Mock Ammonia Drill"Tab <br /> Email a Copy To—reRulatorycomDlianceteam@csw¢.com <br /> Electronic Copy Stored—Located in"Emergency Response Programs"Folder on IDEA Page 1 <br />