Document KR2qRX8pNjx9RgqgdRzq2VRgX

ABD00099322 CONDI-A VISTA COMPANY Aberdeen Plant 0 further Investigation Required No further Investigation Required PSM Incident: Q Yes J^] No Initial Incident Report UnitorArea l/Jit </Z - //]&(?&/ Date of Incident S~/S'~// TimeofDay O SHVO A>/% Incident (ex. fire at XYZ exchanger, first aid cut to finger, etc.) ___________________ 5S& ______________ Weather conditions (Clear, cloudy, raining, etc.) CL FAst /L- / <? A.T Location near or where the incident occurred J) 30<? A )c_________________ Type of Incident (Accident, injury, fire, near miss explosion, collision, chemical release, etc.) Ac-c~* OFns T^ yr ^ y fJ #y___________________________________________ Type of Work (Regular operation, shutdown, startup, maintenance, repair, etc.) fltfC Material Involved: Name Hi -P/tF E/t Quantity ? Equipment Involved /// P/l 0 - O A c A/t SSo /re u, at/ f Injuries Involved _____ No )C Yes Names of Injured Persons and Brief Description of Injuries: Ta/n/My 0* 't-<? Lis r y' & ?r hfA/a. o HAf S/y 9. Witness(es) to the Incident: /Is /t-~ 10. Incident Description (Events prior to, during, and after the incident): Complete on back of form if more space is needed. S' & A Y-LA- Z> Report Prepared By: l A-A Q Date: S~ /S' Title: (y i n.y sAiH'T So fs&tf________ Distribution: Department Heads, Safety and Health Manager 9 ADD00099323 4S "/f- ? 9 /3- Jt- MM- J _/ t /}:.*? 0c/T O c/ Us &S A^Z/FiFO & tt T <2 ^ /Ay A? sZ-0 ~ (Z c. < <** FZ/zy'. (*.? Z A- >. jz<juZ~ Z / s .JE<2*. *A. g&. tA-g. .4*\j$. Z.g.Z? Z * * - ^-*r.2- . c-.a/zt* > /V. ST/f/i ^ C._ . At S'a 4/ _ G.-*Jf. &*F?J As^ #1-5- _ i-/i/<giC~_#.ft <?. A r&r ZFtfZSTM' Q . /Z j^_&-_s_ ...jMM c~A_ XA. yf f /XO _<W/f/2r //<?As- - /t *z& ^ &'i~ /Vt g ^ Sb'f-g', Z'Ag &#**/*/> ..MJ.**. Mh/i.-.. .*-. c-0.c/Hj6&s* Mg z-zco v s *? M^o A si > F- c~.es ?Z}^ ^*5 F T rr~&- f'Uy a . M* 5 /uF^-Sr 3^ 5 ~T~AM*Mys A / ^ ...Mg. *&=Z.5 2^ A- TfaB /#^/vV^ & F &&&Ztzr .MM.. zA &_ st-As^e <u*u e a. & >