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Feb, 18. 2011 10, 21AM 01_1"1 CHLOR ALKALI PRODUCTS No, 1854 P. 2 <br /> EMERGENCY RELEASE FOLLOW-UP NOTICE REPORTING FORM <br /> BUSINESS NAMEPiorieer. AmeriC FACILITY EMERGENCY CONTACT&PHONE NUMBER <br /> ba OlinChlorAlkaliProd is Elizabeth Muse 209) 221 --6206 <br /> INCIDENT MO DAY YR TIME DATE 1 TIM (use 24 hrt[meT70;F_-S���� <br /> INCIDENT ADDRESS LOCATION <br /> J�TINICOMMUNIN COUNTY ZIP6700 S Santa Road rac an,7oa uin 95304 <br /> CHEMICAL OR TRADE NAME (print or type) CAS Number <br /> CHECK IF CHEMICAL IS LISTED IN CHECK IF RELEASE REQUIRES NOTIFI- ❑ <br /> 40 CFR 365, APPENDIX A CATION UNCER 42 U.S.C. Section 9603(a) <br /> PF <br /> ICAL <br /> SOLID TA� QUIDINE❑GAS PHYSICAL <br /> O D$TMLQU DSED© GAS QUANTITY <br /> 2�lb��SED <br /> ENVIRONMENTAL CONTAMINATION TIME OF RELEASE DURATION OF RELEASE <br /> UAIR 0 WATER ❑GROUND❑OTHER 13 :21 —DAYS�HOUR�MINU <br /> ACTIONS TAKEN ( 1 ) EmergenCy shutdown system activated. (2) <br /> P <br /> r_nntacterl for <br /> L tion <br /> of i in s stem ti htenin flan e to stop 1 ak <br /> (5) Piping System replaced prior to reStart of equipment <br /> KNOWN OR ANTICIPATED HEALTH EFFECTS (Use the comments aectlon for addition Inromtation) <br /> ❑ ACUTE OR IMMEDIATE(explaln) <br /> ❑ CHRONIC OR IDELAYED(explain) None <br /> ❑ NOTKNOWN (exptaln) <br /> ADVICE REGARDING MEDICAL ATTENTION NECESSARY FOR EXPOSED INDIVIDUALS <br /> kME"NDICATE SECTION (A•G)AND ITEM WTHCOMM ENTSORADDITIONAL INFORMATION) <br /> ad not been exc d <br /> a <br /> inside, build <br /> CERTIFICATION: I cartlfy under penalty of law that I have personally examined and I am famlllar with the Information <br /> I sub milled"belleve the sui)mltted Information is true,accurate,and complete. <br /> REPORTING FACILITY REPRESENTATIVE (pdnl or type) <br /> SIGNATURE OF REPORTING FACILITY REPRESENTATIVE QL DATE: <br />