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Home My WebLink AboutHAZMAT 15-2834 - 13435 INTERURBAN AVE S - CHEMICAL SPILL OR LEAK ON 7/8/201513435 INTERURBAN AVE S CHEMICAL SPILL OR LEAK HAZMAT # 15-2834 Incident Report 2015-1502834 -000 Tukwila Fire Department 1s-2-s3q- D 6L, Cc1 D€ Hazmat Chemicals Chemical Name DOT ID CAS Registration Chemical ID Container Type Estimated Container Capacity Capacity Units Estimated Amount Released Released Units Sodium hydroxide(solution) UU - Undetermined 1310-73-2 1824 11 - Drum 200 12 - Gallons 10 12 - Gallons Page 1 of 3 Printed: 07/08/2015 23:09:53 Basic Alarm Date and Time 14:43:31 Wednesday, July 8, 2015 Arrival Time 14:49:51 Controlled Date and Time Last Unit Cleared Date and Time 15:56:42 Wednesday, July 8, 2015 Response Time 0:06:20 Priority Response Yes Completed Yes Fire Department Station 52 Shift C Incident Type 422 - Chemical spill or leak Initial Dispatch Code SERVIC Aid Given or Received N - None Alarms 1 Action Taken 1 32 - Provide basic life support (BLS) Casualties No EMS Provided Yes Apparatus - EMS 1 Apparatus - Other 1 Personnel - EMS Personnel 3 Personnel - Other 3 Hazardous Material Released 0 - Special hazmat actions required or spill >= 55 gallons Property Use 571 - Service station, gas station Location Type Address Address 13435 Interurban AVE S City, State Zip Tukwila, WA 98168 District 002 Census Tract 0262.00 Directions 13435 INTERURBAN AVE S Hazmat Outside of Structure 1 Area Affected 1 - Square Feet Area Affected Unites Cause of Release 10 2 - Unintentional release 0� Factors Contributing To Release 1 54 - Other part failure, leak, or break Disposition 8 - Released to property owner or manager Equipment Type NNN - None Hazmat Chemicals Chemical Name DOT ID CAS Registration Chemical ID Container Type Estimated Container Capacity Capacity Units Estimated Amount Released Released Units Sodium hydroxide(solution) UU - Undetermined 1310-73-2 1824 11 - Drum 200 12 - Gallons 10 12 - Gallons Page 1 of 3 Printed: 07/08/2015 23:09:53 Incident Report 2015-1502834 -000 Tukwila Fire Department Page 2 of 3 Printed: 07/08/2015 23:09:53 Hazmat Chemicals Physical State When Released Released Into 2 - Liquid 3 - Ground Apparatus - E52 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Action Taken 1 Apparatus Action Taken 2 Apparatus Type Personnel 1 Personnel 2 Personnel 3 E52 0:06:20 14:43:31 Wednesday, July 8, 2015 14:45:02 Wednesday, July 8, 2015 14:49:51 Wednesday, July 8, 2015 15:56:42 Wednesday, July 8, 2015 Yes 3 2 32 - Provide basic life support (BLS) 44 - Hazardous materials leak control & containment 11 - Engine TF1131 - Wojcik, Peter Position: CAPT Personnel Action Taken 1: 32 - Provide basic life support (BLS) Personnel Action Taken 2: 44 - Hazardous materials leak control & containment TF1166 - Butler, Wesley Position: FFI Personnel Action Taken 1: 32 - Provide basic life support (BLS) Personnel Action Taken 2: 44 - Hazardous materials leak control & containment TF2155 - Fink, Matt Position: FFIII Personnel Action Taken 1: 32 - Provide basic life support (BLS) Personnel Action Taken 2: 44 - Hazardous materials leak control & containment Apparatus - E53 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Action Taken 1 Apparatus Type Personnel 1 Personnel 2 Personnel 3 E53 0:08:48 14:52:31 Wednesday, July 8, 2015 14:53:58 Wednesday, July 8, 2015 15:01:19 Wednesday, July 8, 2015 15:31:14 Wednesday, July 8, 2015 Yes 3 0 44 - Hazardous materials leak control & containment 11 - Engine TF1144 - Mael, Charles Position: CAPT TF1158 - Brooks, Merle Position: FFI TF1183 - Rookstool, Edward Position: FFI Page 2 of 3 Printed: 07/08/2015 23:09:53 Incident Report 2015-1502834 -000 Tukwila Fire Department Authority Reported By Officer In Charge Reviewer TF2155 - Fink, Matt 18:52:18 Wednesday, July 8, 2015 TF1131 - Wojcik, Peter 18:52:24 Wednesday, July 8, 2015 Narratives Narrative Name Narrative Type Narrative Date Author Author Rank Author Assignment Narrative Text 1502834 Incident 22:54:31 Wednesday, July 8, 2015 TF1131 - Wojcik, Peter CAPT 1 At 1443 hours on Wednesday July 8, 2015 we were dispatched to a chemical spill/leak. Two units were assigned to this incident. Six personnel responded. We arrived on scene at 1449 hours and cleared at 1556 hours. The incident occurred at 13435 Interurban Ave S, Tukwila in District 002. The local station is 52. The general description of this property is service station, gas station. The primary task(s) performed at the scene by responding personnel was to provide basic life support (BLS). Other special hoz mat actions were also taken. No mutual/automatic aid was given or received. One patient was involved with this incident. Alarm number 1502834 has been assigned to this incident. E52 dispatched to a service call for a leaking soap tank at Pacific Pride. Enroute told the RP had injuries due to contact with product. E52 on location found a 200 gallon container of Sodium Hydroxide that had a slow leak. The RP was filling smaller containers when the valve/hose broke. He jammed a rag into the hole.E52 requested E53 and an ambulance. E52 used a prowler pool to catch the leaking product. E52 used Amerizorb and dirt to absorb and stop the product from entering a storm drain.E52 established command and started patient care. the patient removed clothing and was deconned with water before going into the ambulance. E53 arrived and stopped the leak using a wooden dowel. E53 returned. E52 remained on location to make contact with the supervisor and arrange cleanup. The supervisor (Selim Abounader) arrived and said he had contacted Chem station (206-768-6920) to clean up the spill. E52 marked the area with scene tape and left the scene to Mr. Abounader. End of Report Page 3 of 3 Printed: 07/08/2015 23:09:53 CAD/Ti Detailed History for Fire Inc #TF150002491 As of 7/08/2015 16:04:56 Output for: TF1138 Priority:4 Type:SERVIC - Non Aid Service Location:PACIFIC PRIDE GAS, TUK at 13435 INTERURBAN AVE S, TUK LocCross:btwn NB ON RAMP and 52ND AVE S Created: 07/08/201514: 42:47 CRO5 V01165 Entered: 07/08/201514:43:28 CRO5 V01165 Dispatch: 07/08/201514:43:31 FD23 V01152 En route: 07/08/2015 14:45:02 TFM519 TF1131 Onscene: 07/08/2015 14:49:51 SP92 V01080 Closed: 07/08/2015 15:56:42 FD25 V01066 ICUnit: PrimeUnit:E52 Dispo: Type:SERVIC - Non Aid Service Agency:TF Group:FIR3(T9) Station:52 Map Box:TF815E Case #:CTF150002834 ❑ Detail Page 1 of 2 )5-2213* 14:42:47 CREATE 14:42:47 ALI 14:43:00 ALI 14:43:00 ALIGEO 14:43:04 ALI 14:43:04 ALIGEO 14:43:28 ENTRY 14:43:28 -SELECT 14:43:28 -SGGEST 14:43:28 -PREMIS 14:43:31 DISP Location:PACIFIC PRIDE GAS, TUK Type:SERVIC Group:T9 RD/MapBox:TF815E TypeDesc:Non Aid Service LocDesc:at 13435 INTERURBAN AVE S, TUK LocCross:btwn NB ON RAMP and 52ND AVE S Priority:4 Response:1E Agency:TF LocType:C E911Phne:425/471-6089 E911PiIot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH1 AliLong:-122.269012 AliLatitude:47.483917 Uncertainty: 1709 E911Phne:425/471-6089 E911PiIot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH2 AliLong:-122.264915 AliLatitude:47.480528 Uncertainty:488 GeoLong:-122.264915 GeoLat:47.480528 ClosestAdd:13712 INTERURBAN AVE S AddDesc:80 ft NE Closestlnt:INTERURBAN AVE S / 52ND AVE S InterDesc:881 ft SE Areal:TP20 Area2:TF865 E911Phne:425/471-6089 E911Pilot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH2 AliLong:-122.264915 AliLatitude:47.480530 Uncertainty:488 GeoLong:-122.264915 GeoLat:47.480530 ClosestAdd:13712 INTERURBAN AVE S AddDesc:81 ft NE Closestlnt:INTERURBAN AVE S / 52ND AVE S InterDesc:881 ft SE Areal:TP20 Area2:TF865 Response:1E-->SERVICTF Comment:SOAP TANK LEAKING ...UNABLE TO SHUT IT OFF.. Unit:E52 Comment:PPR, FPR E52 Operator:TF1131 TF2155 TF1166 OperNames:WOJCIK, PETE; FINK, MATT; BUTLER, WES 14:43:31 -PRIU 1,3/ 14:43:31 -CASE E52 Case#:CTF150002834 14:45:02 *ENRTE E52 14:45:37 INFO Name:GRAGEN, DARYL/EMP Phone:425/471-6089 Comment:APPROX 20 GALS HAS SPILLED OUT..RP SAYS TANK HOLDS OVER 80 GALS RP ALSO 65 YOM, BURNING FEELING ON LEGS. 14:45:44 NOMORE 14:46:40 BACKUP TRI3 UnitID:E52 Location:PACIFIC PRIDE GAS, TUK 14:48:13 REDIR E52 Group:T9—>FIR3 14:48:28 MISCA Comment:TRIMED FROM TUK Q'S 14:48:51 AIQ TRI3 14:48:51 CLEAR TRI3 14:49:51 ONSCN E52 14:52:31 BACKUP E53 UnitID:E52 Location:PACIFIC PRIDE GAS, TUK Operator:TF1144 TF1158 TF1183 http://vcc-tib-webB780LiveCAD/Html/SystemDocs/CADInterface.aspx?CHQ+CTF 15000... 7/8/2015 CAD/Ti Page 2 of 2 OperNames:MAEL, CHUCK (R51 TEAM LDR); BROOKS, MERLE; ROOKSTOOL, EDWARD 14:52:42 CLOS E52 Location:INTERURBAN COMMAND 14:53:58 *ENRTE E53 14:54:01 *ENRTE E53 15:01:19 *ONSCN E53 15:31:14 *AOR E53 15:31:14 *CLEAR E53 15:56:42 CLEAR E52 15:56:42 -PRIU E52 15:56:42 -CLEAR 15:56:42 CLOSE CONTACT INFO: Name Phone RPaddr RPCon? IDCCOde AltPhn RPCon4 GRAGEN, DARYL/EMP 425/471-6089 httn://vcc-tib-webB780LiveCAD/Htm1/SvstemDocs/CADInterface.asnx?CHQ+CTF 15000... 7/8/2015 IUNU (JUUN 1 Y MLUILPAL IN(.:IUtN 1 HtF'UH 1 I-UHM Agency Name { Agency No. 1 �it IG :co Incident # 1 S— z<119 Mo. o 11 Day QJ: 55 Yr. t jS Incident Address City 34Ss -S,S. 4615857 Patient Name (Lst, First, VQS'N4 ddle c..fvaA nt.) Parent or Legal Guardian Birthdate tties,1q Age (g$ GENDER Er ❑F ❑Unk Pt # 61 of of e & State Phone P ent Addss VII e0 l(A� - S %Cty 7 Z i VIP• I CIS (I Patient Healthcare Provider Medical Control Physician/Hospital Time AFTERCARE Not Low Blood High Blood Community 9 ❑ Transported ❑ Sugar ❑ Pressure Falls ❑ Resources Time 1"( :Sci4 : O g : : Notes GCS Blood Pressure ?sot p Zto / id / / / / / NAG Pulse Rate 4 CO- antareous Respiratory Rate ` VQ 3 ,o 0027-3 2 0 pa `I 1 No Response ECG Rhythm Oxygenmin) t Confused 3 Inapp�o'oon t;a 2 Inreraeto stole 1Nure"ore Pulse Oximetry (%) Glucometry (mg/dl) IV fluids (liters) DC Shock (joules) `/ (—MOTOR 5 Locates Poi". 4 4'rifhcr2;r, 3 Flexon 2 Exters on 1 NO res: ors: Home Medication,❑ None Allergies one Narrative: cos ukirt,.�-1c 0 L GVI des rYL1la r -L STROKE Yf N Aro drat o co Vv '^ `1�V�1fP N s bC \ 0 LL -e -s �- t- 'Avfi4•.� /L w 1,�r l�tw� a.,�� 4-\� s 9at.tk. ►t}1A r ti,. 6►-a6a '� P speed _. Ire of :;rnv i L1 EC aver; C c_ SEPSIS Y / N Neve° C 1a c -IF,: SE3f' L7 +`C OSI ►"-� y L OA � � i 0...e.AA, STENO A3.A Q v n C _ Syr•ptom G€is& fsl �7�sJ\ �7v 1 vl � .u� \S 4v�e tc ei,-1 1. -,LA s C; a Pr Person ompleti g Form (PLEASE PRINT) Al X Ak l/ 'tiL Signature o rso pleting Form ■UIP1no111 EMT Crew Names Paramedic crew names: 11.J t<114 2\ e 3 1 2 3 **This document contains only a portion of the EMS report and does not constitute the full EMS record** AGENCY COPY ALS/BLS M10/P13 Refusal of Medical Evaluation, Treatment and/or Transportation The patient is at least 18 years old and does not appear to be experiencing any altered mental status and appears to have the caacityzto understand the current situation. "I hereby acknowledge that I have been advised by emergency medical personnel that evaluation, treatment and/or transportation are necessary for my condition. I have also been informed that I risk medical consequences if 1 refuse to be examined, treated and/or transported by emergency medical personnel. I hereby state my refusal to follow this advice and refuse further evaluation, treatment and/or transportation to a medical facility." Patient's Name: Date: Patient's Signature: Date" Parent/Guardian Signature: Date. EMT or Paramedic Signature: Date - Witness Signature: Date. Witness EMS Agency Affiliation or Address: Instructions for EMS Personnel 1) Complete this form in ink. 2) Fill in patient's name, and the date. 3) Read the statement slowly and clearly to the patient. Ask if they understand what it says. 4) Have the patient sign on the "Patient Signature" line, or on the "Parent/Guardian" line if appropriate. If the patient or parent/guardian refuses to sign, or you are unable to obtain a signature for any other reason, simply make a note to that effect, sign the form and have it witnessed. 5) Obtain a signature from a witness (preferably someone from your agency), and note that person's EMS agency affiliation or address. CAD/Ti Detailed History for Fire Inc #TF150002491 As of 7/08/2015 16:04:56 Output for: TF1138 Priority:4 Type:SERVIC - Non Aid Service Location:PACIFIC PRIDE GAS, TUK at 13435 INTERURBAN AVE S, TUK LocCross:btwn NB ON RAMP and 52ND AVE S Created: 07/08/2015 14:42:47 CRO5 V01165 Entered: 07/08/2015 14:43:28 CRO5 V01165 Dispatch: 07/08/201514:43:31 FD23 V01152 Enroute: 07/08/2015 14:45:02 TFM519 TF1131 Onscene: 07/08/2015 14:49:51 SP92 V01080 Closed: 07/08/2015 15:56:42 FD25 V01066 ICUnit: PrimeUnit:E52 Dispo: Type:SERVIC - Non Aid Service Agency:TF Group:FIR3(T9) Station:52 Map Box:TF815E Case #:CTF150002834 0 Detail Page 1 of 2 )5-2231- 14:42:47 CREATE 14:42:47 ALI 14:43:00 ALI 14:43:00 ALIGEO 14:43:04 ALI 14:43:04 ALIGEO 14:43:28 ENTRY 14:43:28 -SELECT 14:43:28 -SGGEST 14:43:28 -PREMIS 14:43:31 DISP Location:PACIFIC PRIDE GAS, TUK Type:SERVIC Group:T9 RD/MapBox:TF815E TypeDesc:Non Aid Service LocDesc:at 13435 INTERURBAN AVE S, TUK LocCross:btwn NB ON RAMP and 52ND AVE S Priority:4 Response:1E Agency:TF LocType:C E911Phne:425/471-6089 E911PiIot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH1 AliLong:-122.269012 AliLatitude:47.483917 Uncertainty:1709 E911Phne:425/471-6089 E911PiIot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH2 AliLong:-122.264915 AliLatitude:47.480528 Uncertainty:488 GeoLong:-122.264915 GeoLat:47.480528 ClosestAdd:13712 INTERURBAN AVE S AddDesc:80 ft NE Closestlnt:INTERURBAN AVE S / 52ND AVE S InterDesc:881 ft SE Areal:TP20 Area2:TF865 E911Phne:425/471-6089 E911Pilot:253/511-4248 E911Add:13400, TUK E911Subs:AT&T MOBILITY E911Srce:WPH2 AliLong:-122.264915 AliLatitude:47.480530 Uncertainty:488 GeoLong:-122.264915 GeoLat:47.480530 ClosestAdd:13712 INTERURBAN AVE S AddDesc:81 ft NE Closestlnt:INTERURBAN AVE S / 52ND AVE S InterDesc:881 ft SE Areal:TP20 Area2:TF865 Response:1E—>SERVICTF Comment:SOAP TANK LEAKING ...UNABLE TO SHUT IT OFF.. Unit:E52 Comment:PPR, FPR E52 Operator:TF1131 TF2155 TF1166 OperNames:WOJCIK, PETE; FINK, MATT; BUTLER, WES 14:43:31-PRIU E52 14:43:31 -CASE E52 Case#:CTF150002834 14:45:02 *ENRTE E52 14:45:37 INFO Name:GRAGEN, DARYL/EMP Phone:425/471-6089 Comment:APPROX 20 GALS HAS SPILLED OUT..RP SAYS TANK HOLDS OVER 80 GALS RP ALSO 65 YOM, BURNING FEELING ON LEGS. 14:45:44 NOMORE 14:46:40 BACKUP TRI3 UnitID:E52 Location:PACIFIC PRIDE GAS, TUK 14:48:13 REDIR E52 Group:T9-->FIR3 14:48:28 MISCA Comment:TRIMED FROM TUK Q'S 14:48:51 AIQ TRI3 14:48:51 CLEAR TRI3 14:49:51 ONSCN E52 14:52:31 BACKUP E53 UnitID:E52 Location:PACIFIC PRIDE GAS, TUK Operator:TF1144 TF1158 TF1183 http://vcc-tib-webB780LiveCAD/Html/SystemDocs/CADlnterface.aspx?CHQ+CTF 15000... 7/8/2015 CAD/Ti Page 2 of 2 OperNames:MAEL, CHUCK (R51 TEAM LDR); BROOKS, MERLE; ROOKSTOOL, EDWARD 14:52:42 CLOS E52 Location:INTERURBAN COMMAND 14:53:58 *ENRTE E53 14:54:01 *ENRTE E�53 15:01:19 *ONSCN E53 15:31:14 *AOR E53 15:31:14 *CLEAR E53 15:56:42 CLEAR E52 15:56:42 -PRIU 15:56:42 -CLEAR 15:56:42 CLOSE CONTACT INFO: Name Phone RPaddr RPCon? IDCCode AltPhn RPCon4 GRAGEN, DARYL/EMP 425/471-6089 http://vcc-tib-webB780LiveCAD/Html/SystemDocs/CADlnterface.aspx?CHQ+CTF 15000... 7/8/2015