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GSE(DeVE'D <br /> ENVIRONAyfN1 <br /> EMERGENCY RELEASE FOLLOW- UP NOTICE REPORTING FOR 1TH <br /> Corn Products , Stockton Pla Roger HoffdahlcoNTAcrsP204�982 192N"V0I� S <br /> INCIDENT MO DAY YR I TIME IDES <br /> DATE 101612 2 1110 OES 10191310 (use 24tvtime) CONTROLNO. 1 0 3171815 <br /> INCIDENT ADDRESS LOCATION CIN/COMMUNITY COUNT/ ZIP <br /> 1021 Industrial Drive Stockton San Joaquin 95206 <br /> CHEMICAL OR TRADE NA ME (print or type) CAS Number <br /> NALCO 3DT289 CoolingWater Treatment 7664-38-2 <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIR- ❑ <br /> 40 CFR 355, APPENDIX A ❑ CATION UNDER 42 U.S.C. Section 9603(a) <br /> PHYSICAL SOLID TA❑ pU DINED GAS PHYSICCAL STATE RE RELEASED GAS QUANTITY RELEASED <br /> ❑ ❑ ® ❑ 5-10 gallons <br /> ENVIRONMENTAL CONTAMINATION TIMEOFRELEASE DURATION OFRELEASE <br /> ❑AIR ❑WATER UGROUND❑OTHER 0900 .Q-DAYS$HOURS-1MINU <br /> ACTION TAKEN <br /> Upon Isco er transport driver shut the delivery puMn on bjS_Irllrk <br /> off. Spilled liquid was contained by the driver. Hazardous Waste Re- <br /> s onse contractor hire b NALCO to cleanup. Absorbent a d r <br /> for disposal . Cleanup complete by 1500 hrs . <br /> Spill occurred on pavement adjacent to cooling tower, no release to <br /> soil , storm drain and/or industrial sewer dr i <br /> LADVICEREGARTDIN'G <br /> ATED HEALTH EFFECTS (Use the comments section for addition information) <br /> MMEDIATE(explain) skin contact corrosive H 1 .8 <br /> R DELAYED(explain) <br /> N(explain) <br /> MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> COMMENTS (INDICATE SECTION (A-G)AND ITEM WITH COMMENTS OR ADDITIONAL INFORMATION) <br /> Nor.t_—Pmerqency notification <br /> SJ Count CUPA Environmental Health Det and California State Warnin <br /> Center OES, contact Ron ,report # 10-3785. On site attendance during <br /> c eanup and inspection by County REHS, Ray von Flue. <br /> CERTIFICATIO777� <br /> penalty of law that I have personally examined and I am familiar with the information <br /> submitted and itted information is true,accurate,and complete. <br /> REPORTING ENTATIVE (print ortype) Ro er W Hof d <br /> SIGNATURE CILITY REPRESENTATIVE ATE: 0 <br />