AMMONIA RELEASE REPORTING GUIDELINES - Salinas Valley ...

FORM: EPR-1
EMERGENCY NOTIFICATION
INFORMATION TO HAVE WHEN MAKING THE REPORT CALLS
1. Your Name:
2. Date:
3. Company/Responsible Operation Name:
4. Site Address:
5. Duration of the release (not total time of incident but total spill time):
6. Medium or Media: AIR WATER GROUND
7. Number of injured (if any):
8. Number hospitalized (if any):
9. Number of persons evacuated from
neighboring facilities or residences (if any)
10. Estimate the quantity lost. From most equipment, relief valves are set at less than 60 Lb per minute
of Ammonia (equivalent to 81 Lb per minute of Air) release rate). A rough estimate would be 1 Lb
per second of ammonia released. (Field verify for greater accuracy)
____________Seconds X 1 LB/Second = ________________ Lb Approximate Quantity Released.
11. Do you have a completed Form EPR-2 in hand?
MAKE THE FOLLOWING CALLS
12. Document the name of person on the other end of the telephone line.
• State Office of Emergency Services (OES) (1-800-852-7550)
• Name: Date:
Time Case #
• Local Administering Agency (AA / CUPA) (831 755 4511 – Monterey County)
Name: Date:
Time Case #
• National Response Center: (1-800-424-8802)
Name: Date
Time Case
(Standard Form used with permission of WPS)
DISCLAIMER: This form is intended to serve as a reference for facility personnel in their development of facility
reporting policy