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“Terrorism Concerns Results in Chemical Storage Rule Delay” #WestTexasFire #Chemicals

The Trump administration is delaying a new rule tightening safety requirements for companies that store large quantities of dangerous chemicals. The rule was imposed after a fertilizer plant in West, Texas, exploded in 2013, killing 15 people.

Scott Pruitt, the administrator of the Environmental Protection Agency, delayed the effective date of the Obama-era rule until June.

Pruitt’s action late Monday came in response to complaints by the chemical industry and other business groups that the rule could make it easier for terrorists and other criminals to target refineries, chemical plants, and other facilities by requiring companies to make public the types and quantities of chemicals stored on site.

The EPA issued a final rule in January, seven days before President Barack Obama left office. The EPA said at the time that the rule would help prevent accidents and improve emergency preparedness by allowing first responders better data on chemical storage.

A coalition of business groups opposed the rule, saying in a letter to Pruitt that it would do “irreparable harm” to companies that store chemicals and put public safety at risk.

Chet Thompson, president and CEO of the American Fuel and Petrochemical Manufacturers, an industry group, praised Pruitt’s delay of the EPA rule.

“The midnight rulemaking in the final days of the Obama administration would not enhance safety, create security vulnerabilities and divert resources from further enhancing existing safety programs,” Thompson said.

Environmental groups questioned industry claims as “self-interested” and misleading.

Hazardous chemical incidents like the explosion in West, Texas, are “frighteningly common,” according to the Environmental Justice Health Alliance, an advocacy group. More than 1,500 chemical releases or explosions were reported from 20014 to 2013, causing 58 deaths and more than 17,000 injuries, the group said.

Instead of bowing to industry complaints, the EPA should “stand with the first responders, at-risk communities, safety experts, workers, small businesses and others who live at daily risk of a catastrophic chemical release or explosion,” the group wrote in a letter last month to members of Congress.

The Obama-era rule came after a three-year process that included eight public hearings and more than 44,000 public comments, the group said.

The Obama administration said the rule would help prevent chemical incidents such as the 2013 explosion in Texas, while enhancing emergency preparedness requirements, improving management of data on chemical storage and modernizing policies and regulations.

Sen. Jim Inhofe, R-Okla., said the Obama-era rule gives “a blueprint to those who would like to do us harm,” adding that existing regulations will remain in place to continue ensuring the safety of chemical plants and other facilities.

Source: Insurance Journal

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“CSB Releases New Safety Video Detailing Investigation into 2013 Fatal Fire and Explosion at the Williams Olefins Plant in Geismar, LA”

January 25, 2017, Washington, DC –

Today the U.S. Chemical Safety Board (CSB) released a safety video of its investigation of the June 13, 2013 explosion and fire at the Williams Olefins Plant in Geismar, Louisiana, which killed two workers and injured an additional 167.  The deadly explosion and fire occurred when a heat exchanger containing flammable liquid propane violently ruptured.

The CSB’s newly released 12-minute safety video entitled, “Blocked In,” includes a 3D animation of the explosion and fire as well as interviews with CSB investigator Lauren Grim and Chairperson Vanessa Allen Sutherland. The video is based on the CSB’s case study on the Williams incident and can be viewed on the CSB’s website and YouTube.

Chairperson Sutherland said, “Our investigation on the explosion at Williams describes an ineffective process safety management program at the plant at the time of the incident. We urge other companies to incorporate our recommendations at their facilities and to assess the state of their cultures to promote safety at all organizational levels to prevent a similar accident. ”

The CSB’s investigation found many process safety management program deficiencies at Williams, which set the stage for the incident. In particular, the CSB found that the heat exchanger that failed was completely isolated from its pressure relief valve.

In the video, Investigator Lauren Grim said, “When evaluating overpressure protection requirements for heat exchangers, engineers must think about how to manage potential scenarios, including unintentional hazards. In this case, simply having a pressure relief valve available could have prevented the explosion.”

The CSB investigation concluded that in the twelve years leading to the incident, a series of process safety management program deficiencies caused the heat exchanger to be unprotected from overpressure.  As revealed in the investigation, during that time Management of Change Reviews, Pre-Startup Safety Reviews, and Process Hazard Analyses all failed to effectively identify and control the hazard.

In addition, the CSB found that Williams failed to develop a written procedure for activities performed on the day of the incident, nor did the company have a routine maintenance schedule to prevent the operational heat exchanger from needing to be shut down for cleaning.

Finally, the video describes CSB’s recommendations made to the Williams Geismar plant which  encourages similar companies to review and incorporate into their own facilities. These include:

– Conduct safety culture assessments that involve workforce participation, and communicate the results in reports that recommend specific actions to address safety culture weaknesses

– Develop a robust safety indicators tracking program that uses the data identified to drive continual safety improvement

– And perform comprehensive process safety program assessments to thoroughly evaluate the effectiveness of the facility’s process safety programs.

“Managers must implement and then monitor safety programs and encourage a strong culture of safety to protect workers and the environment,” Chairperson Vanessa Allen Sutherland said,

The CSB is an independent federal agency charged with investigating serious chemical accidents. CSB investigations examine all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems.

The Board does not issue citations or fines but makes safety recommendations to companies, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Please visit our website, http://www.csb.gov.

For more information, contact Communications Manager Hillary Cohen at public@csb.gov or by phone at 202.446.8095.

 

“Regulated Industry Successfully Challenges New OSHA Process Safety Management Enforcement Policies”

On September 23, 2016, the D.C. Court of Appeals ruled that the Occupational Safety and Health Administration (OSHA) wrongfully adopted new safety requirements for fertilizer dealers who have to comply with the Process Safety Management Standard. Specifically, OSHA improperly issued a memorandum redefining the “retail facility” exemption and did not allow fertilizer dealers to comment on the new rules.

OSHA has promulgated a Process Safety Management (PSM) standard that implements certain requirements for employers to protect the safety of those who work with or near highly hazardous chemicals, and help prevent unexpected releases of such chemicals. Traditionally, retail establishments do not have to comply with the PSM standard because hazardous chemicals are present only in small volumes in such instances.

Following a 2013 explosion at a West Texas Fertilizer facility (videos above) that left 15 people dead after a large amount of ammonium nitrate caught fire, OSHA issued an enforcement memorandum expanding the scope of the PSM standard to cover more retail establishments, including agricultural dealers who sell anhydrous ammonia to farmers. Yet OSHA did this without requesting comments from the public or industry.

Working with legal counsel, the Agricultural Retailers Association (ARA) and The Fertilizer Institute organized a successful lawsuit challenging the new rule. The D.C. Court of Appeals ruled that OSHA violated the Occupational Safety and Health Act when it issued the enforcement memorandum, finding that OSHA had engaged in rulemaking, and was thus bound to solicit comments from the public and industry. As a result of the successful lawsuit, ag retailers do not have to comply with the PSM standard until OSHA receives comments from the public and industry regarding the proposed changes to the PSM standard, which could take several years to finalize.

Commenting on the decision, Harold Cooper, chairman of the ARA, said that “[a]s an industry, ag retailers tend to be complacent about regulations that come our way. We keep our heads down and do what’s required,” he said. “But this rule would have limited farmers’ and retailers’ options through an agency’s improper regulatory overreach. Thankfully, ARA was uniquely prepared and positioned to defend our industry. They gave us a vehicle to fight and win this battle.”

The court’s ruling will make it more difficult in the future for OSHA to issue de facto standards without undertaking proper rulemaking procedures and soliciting comments from the public. Companies should proactively work with skilled legal counsel who can assist on rulemaking processes that impact workplace health and safety.

Source: 9/27/2016 by Daniel BirnbaumMichael Taylor  | BakerHostetler

 

 

 

 

 

“U.S. Chemical Safety Board Releases New Safety Video, “Dangerously Close: Explosion in West, Texas,” Detailing Report Findings and Recommendations on 2013 Fatal West Fertilizer Company Explosion and Fire “

January 29, 2016, Washington, DC – Today the U.S. Chemical Safety Board (CSB) released a safety video into the fatal April 17, 2013, fire and explosion at the West Fertilizer Company in West, Texas, which resulted in 15 fatalities, more than 260 injuries, and widespread community damage. The deadly fire and explosion occurred when about thirty tons of fertilizer grade ammonium nitrate (FGAN) exploded after being heated by a fire at the storage and distribution facility.

The CSB’s newly released 12-minute safety video entitled, “Dangerously Close: Explosion in West, Texas,” includes a 3D animation of the fire and explosion as well as interviews with CSB investigators and Chairperson Vanessa Allen Sutherland. The video can be viewed above or on the CSB’s website and YouTube.

Chairperson Sutherland said, “This tragic accident should not have happened. We hope that this video, by sharing lessons learned from our West Fertilizer Company investigation, will help raise awareness of the hazards of fertilizer grade ammonium nitrate so that a similar accident can be avoided in the future.”

The CSB’s investigation found that several factors contributed to the severity of the explosion, including poor hazard awareness and fact that nearby homes and business were built in close proximity to the West Fertilizer Company over the years prior to the accident. The video explains that there was a stockpile of 40 to 60 tons of ammonium nitrate stored at the facility in plywood bins on the night of the explosion. And although FGAN is stable under normal conditions, it can violently detonate when exposed to contaminants in a fire.

In the video, Team Lead Johnnie Banks says, “We found that as the city of West crept closer and closer to the facility, the surrounding community was not made aware of the serious explosion hazard in their midst. And the West Fertilizer Company underestimated the danger of storing fertilizer grade ammonium nitrate in ordinary combustible structures.”

The CSB investigation concludes that this lack of awareness was due to several factors, including gaps in federal regulatory coverage of ammonium nitrate storage facilities. The video details safety recommendations made to OSHA and the EPA to strengthen their regulations to protect the public from hazards posed by FGAN.

Finally, the video explains how inadequate emergency planning contributed to the tragic accident. The CSB found that the West Volunteer Fire Department was not required to perform pre-incident planning for an ammonium nitrate-related emergency, nor were the volunteer firefighters required to attend training on responding to fires involving hazardous chemicals. As a result, the CSB made several safety recommendations to various stakeholders, including the EPA, to better inform and train emergency responders on the hazards of FGAN and other hazardous chemicals.

Chairperson Vanessa Allen Sutherland said, “The CSB’s goal is to ensure that no one else be killed or injured due to a lack of awareness of hazardous chemicals in their communities. If adopted, the Board’s recommendations can help prevent disasters like the one in West, Texas.”

The CSB is an independent federal agency charged with investigating serious chemical accidents. The agency’s board members are appointed by the President and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems. The Board does not issue citations or fines but makes safety recommendations to companies, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Please visit our website, www.csb.gov

For more information, contact Communications Manager Hillary Cohen at public@csb.gov or by phone at 202.446.8095.

 

“CSB Board Votes on Status of Sixteen Safety Recommendations”

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Washington, DC, April 20, 2015—The U.S. Chemical Safety Board (CSB) has recently voted to update the status of sixteen recommendations resulting from twelve accident investigations including key safety improvements resulting from the 2006 CAI/Arnel fire and explosion in Danvers, MA and the 2005 BP Texas City refinery fire and explosion.  All recently voted on recommendations are highlighted on a newly launched webpage designed to update the public on safety recommendation status changes.
Deputy Managing Director for Recommendations Dr. Susan Anenberg said, “Safety recommendations are the CSB’s primary tool for achieving positive change and preventing future incidents. A recommendation is a specific course of action issued to a specific party, based on the findings of CSB investigations, safety studies, and other products.”
One of the recommendations voted upon by the board was issued to Commonwealth of Massachusetts Office of Public Safety, Department of Fire Services. The recommendation was to incorporate standards set forth by the National Fire Protection Association into the state’s fire regulations and was the result of a powerful explosion and fire that took place at the CAI/Arnel ink and paint products manufacturing facility in Danvers, Massachusetts, on November 22, 2006. On January 1, 2015, the state of Massachusetts adopted a revised fire safety code that incorporates the CSB’s recommendations.
Dr. Anenberg said, “We are very pleased that Massachusetts’ revised fire code includes our recommended safety improvements. Their action ensures that the Board’s accident investigation has a lasting impact on safety in the state.”
Another acceptably closed recommendation is a 2007 recommendation to OSHA to implement a national emphasis program for oil refineries focusing on issues the CSB found contributed to the March 23, 2005, explosion at the BP refinery in Texas City, Texas. In response to the CSB recommendation, OSHA launched a “Petroleum Refinery Process Safety Management National Emphasis Program,” which led to enhanced inspections of over seventy refineries nationwide.
Also, the CSB successfully closed a recommendation made to the National Fire Protection Association to revise standards based on findings from its investigation into the May 4, 2009, explosion and fire at the Veolia facility in West Carrolton, Ohio.
Dr. Anenberg said, “Actions taken by CSB recommendations recipients trigger important safety changes that can prevent accidents and save lives. Our goal is for all CSB safety recommendations to be successfully adopted and we look forward to sharing our progress with the public through our new website feature.”
For a full list of recently updated recommendations please view the CSB’s website at http://www.csb.gov/recommendations/recently-updated/
The CSB is an independent federal agency charged with investigating industrial chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems.
The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Visit our website, www.csb.gov.
For more information, contact CSB Public Affairs at public@csb.gov, Communications Manager Hillary Cohen, cell 202-446-8094 or Sandy Gilmour, Public Affairs, cell 202-251-5496.

“CSB Releases New Safety Video Entitled “Shock to the System” Offering Key Lessons for Preventing Hydraulic Shock in Ammonia Refrigeration Systems”

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Latest Safety Video Includes Detailed Animation of 32,000- Pound Release of Ammonia in Alabama which Led to Offsite Injuries Including Multiple Hospitalizations in 2010

Washington, D.C, March 26, 2015 – Today the US Chemical Safety Board (CSB) released its latest safety video detailing key lessons from the release of 32,000 pounds of anhydrous ammonia that occurred at Millard Refrigerated Services Inc. on August 23, 2010. The accident resulted in over 150 exposures to offsite workers, thirty of which were hospitalized – four in an intensive care unit.

The newly released seven-minute safety video, entitled “Shock to the System,” includes a detailed 3D animation of the events that led up the resulting ammonia release. The video is based on the CSB’s recent View of cracked pipe following the 2010 ammonia release safety bulletin entitled “Key Lessons for Preventing Hydraulic Shock in Industrial Refrigeration Systems.”

Chairperson Rafael Moure-Eraso said, “The CSB’s new safety video is a valuable tool intended for use at the large number of facilities that utilize anhydrous ammonia. The key lessons learned from our investigation – examined in our report and in this video — can help facilities prevent a similar accident from occurring due to hydraulic shock.”

The CSB’s video is available at its YouTube channel and at www.csb.gov

The CSB’s investigation found that the day prior to the accident the Millard facility experienced a loss of power that lasted more than seven hours. During that time the refrigeration system was shut down. The next day, on August 23, 2010, the system regained power and was up and running, though operators reported certain problems.  While doing some troubleshooting an operator cleared alarms in the control system, which reset the refrigeration cycle on a group of freezer evaporators that were in the process of defrosting.

This resulted in both hot, high-pressure gas and extremely low temperature liquid ammonia to be present in the coils and associated piping at the same time. This caused the hot high-pressure ammonia gas to rapidly condense into a liquid.  Because liquid ammonia takes up less volume than ammonia gas – a vacuum was created where the gas had condensed.

The sudden pressure drop sent a wave of liquid ammonia through the piping – causing a sudden pressure surge known as “hydraulic shock.”

This abnormal transient condition results in a sharp pressure rise with the potential to cause catastrophic failure of piping, valves, and other components. Often prior to a hydraulic shock incident there is an audible “hammering” in refrigeration piping,.

CSB Investigator Tyler said, “The CSB’s animation details how the pressure surge ruptured the evaporator piping manifold inside one of the freezers causing a roof-mounted 12-inch suction pipe to catastrophically fail, resulting in the release of more than 32,000 pounds of anhydrous ammonia and its associated 12-inch piping on the roof of the facility.”

The release resulted in injuries to a Millard employee when he fell while attempting to escape from a crane after it became engulfed in the traveling ammonia cloud.  The large cloud traveled a quarter mile from the facility south toward an area where 800 contractors were working outdoors at a clean-up site for the Deepwater Horizon oil spill. A total of 152 offsite workers and ship crew members reported symptomatic illnesses from ammonia exposure. Thirty two of the offsite workers required hospitalization, four of them in an intensive care unit.

The video presents the key lessons learned from the CSB’s investigation including avoiding the manual interruption of evaporators in defrost and requiring control systems to be equipped with password protection to ensure only trained and authorized personnel have the authority to manually override systems. On the day of the incident, the control system did not recognize that the evaporator was already in the process of defrosting, and allowed an operator to manually restart the refrigeration cycle without removing the hot ammonia gas from the evaporator coil.

The CSB also found that the evaporators at the Millard facility were designed so that one set of valves controlled four separate evaporator coils. As a result, the contents of all four coils connected to that valve group were involved in the hydraulic shock event – leading to a larger, more hazardous pressure surge. As a result, the CSB notes that when designing ammonia refrigeration systems each evaporator coil should be controlled by a separate set of valves.

And the CSB found that immediately after discovering the ammonia release, a decision was made to isolate the source of the leak while the refrigeration system was still operating instead of initiating an emergency shutdown. Shutting down the refrigeration system may have resulted in a smaller release, since all other ammonia-containing equipment associated with the failed rooftop piping continued to operate. A final key lesson from the CSB’s investigation is that an emergency shutdown should be activated in the event of an ammonia release if a leak cannot be promptly isolated and controlled. Doing so can greatly reduce the amount of ammonia released during an accident.

The CSB is an independent federal agency charged with investigating serious chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems.

The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Visit our website, http://www.csb.gov.  For more information, contact public@csb.gov.

 

“CSB Names Poor Design and Failure to Test Dust Collection System Among Causes of U.S. Ink New Jersey Flash Fire that Burned Seven Workers in 2012; OSHA Again Urged to Issue New Combustible Dust Regulations”

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OSHA Again Urged to Issue New Combustible Dust Regulations  

East Rutherford, New Jersey, January 15, 2015—The flash fire that burned seven workers, one seriously, at a U.S. Ink plant in New Jersey in 2012 resulted from the accumulation of combustible dust inside a poorly designed dust collection system that had been put into operation only four days before the accident, an View of Dust Collector at US Ink investigation by the U.S. Chemical Safety Board (CSB) has found.

In a report released today and scheduled to be presented for board consideration at a CSB public meeting in East Rutherford this evening, the investigation team concludes that the system was so flawed it only took a day to accumulate enough combustible dust and hydrocarbons in the duct work to overheat, ignite spontaneously, cause an explosion in the rooftop dust collector, and send back a fiery flash that enveloped seven workers.

U.S. Ink is a subsidiary of Sun Chemical, a global graphic arts corporation which has some 9,000 employees worldwide. U.S. Ink manufactures black and color-based inks at seven U.S. locations including East Rutherford. A key step in the ink production process is mixing fine particulate solids, such as pigments and binders, with liquid oils in agitated tanks.

CSB Chairperson Rafael Moure-Eraso said, “The findings presented in the CSB report under consideration show that neither U.S. Ink nor its international parent company, Sun Chemical, performed a thorough hazard analysis, study, or testing of the system before it was commissioned in early October 2012. The original design was changed, the original company engineer retired prior to completion of the project, and no testing was done in the days before the operation of the black-ink pre-mixing room production was started up.”

The CSB found that the ductwork conveyed combustible, condensable vapors above each of three tanks in the mixing room, combining with combustible particles of dust of carbon black and Gilsonite used in the production of black ink.

Investigation Supervisor Johnnie Banks said, “The closed system air flow was insufficient to keep dust and sludge from accumulating inside the air ducts.  But to make matters worse, the new dust collector design included three vacuuming hoses which were attached to the closed-system ductwork, used to pick up accumulated dust, dirt and other material from the facility’s floor and other level surfaces as a ‘housekeeping’ measure.  The addition of these contaminants to the system ductwork doomed it to be plugged within days of startup.”

The report describes a dramatic series of events that took place within minutes on October 9, 2012.  About 1 p.m., an operator was loading powdered Gilsonite, a combustible carbon-containing mineral, into the bag dump station near the pre-mixing room when he heard what he called a strange, squealing sound.  He checked some gauges in the control room, and as he was leaving he saw a flash fire originating from the bag dump where he had just been working.  He left to notify his supervisor.  At about that same time, other workers heard a loud thump that shook the building.

In response to the flash from the bag dump station and the thump, workers congregated at the entrance to the pre-mix room.  One worker spotted flames coming from one of the tanks.  He obtained a fire extinguisher but before he could use it, he saw an orange fireball erupt and advance toward him.  He squeezed the handle on the extinguisher as he jumped from some stairs, just as the flames engulfed him and six other employees who were standing in the doorway.

The CSB determined that overheating and spontaneous ignition which likely caused the initial flash fire at the bag dump was followed by ignition of accumulated sludge-like material and powdery dust mixture of Gilsonite and carbon black in the duct work above tank 306.  Meantime, the dust collection system, which had not been turned off, continued to move burning material up toward the dust collector on the building’s roof, where a sharp pressure rise indicated an imminent explosion. This was contained by explosion suppression equipment, but the resulting pressure reversed the air flow, back to the pre-mix room, where a second flash fire occurred, engulfing the workers.

Investigation Supervisor Banks said, “The new system was not thoroughly commissioned.  There was no confirmation of whether the system would work as configured, missing opportunities to find potential hazards.  The design flaws were not revealed until the dust explosion.”

The report’s safety management analysis points to a lack of oversight by company engineers of the work done by installation contractors. The company chose not to perform a process hazard analysis or management of change analysis – required by company policy for the installation of new processing equipment – because it determined it was merely replacing a previous dust collection system in kind.  However, the new system in fact was of an entirely different design.

Considering the emergency response following the flash fire and dust collector explosion, CSB Investigators found that while workers had received training in emergency response situations, they did not follow those procedures, because U.S. Ink had not developed and implemented an effective hazard communication and response plan.  A fire coordinator was designated to use the public address system to announce a fire and also pull the alarm box. But because the system was not shut down immediately after the first flash fire, he was among the injured and could not perform his duties.

The CSB report’s regulatory analysis highlights the need for a national general industry combustible dust standard which the agency has long recommended that OSHA promulgate, putting in on the CSB’s “Most Wanted” list in 2013, following years of urging action as dust explosions continued to occur in industry.  The report, if adopted by the board, would reiterate the CSB’s original recommendation to OSHA, and also recommend OSHA broaden the industries it includes in its current National Emphasis Program on mitigating dust hazards, to include printing ink manufacturers.

Chairperson Moure-Eraso said, “Although OSHA’s investigation of this accident deemed it a combustible dust explosion, it did not issue any dust-related citations, doubtless hampered by the fact that there is no comprehensive combustible dust regulatory standard.  In U.S. Ink’s case – and thousands of other facilities with combustible dust – an OSHA standard would likely have required compliance with National Fire Protection Association codes that speak directly to such critical factors as dust containment and collection, hazard analysis, testing, ventilation, air flow, and fire suppression.”

The CSB report notes that the volume of air flow and the air velocity in the company’s dust collection system was significantly below industry recommendations – which, in the absence of a federal combustible dust regulation, are essentially voluntary.  The report states the ductwork design did not comply in several respects with guidelines set by the American Conference of Governmental Industrial Hygienists (ACGIH) Industrial Ventilation Manual.  Nor did the system’s design, the CSB said, comply with the voluntary requirements of NFPA 91, which states: “All ductwork shall be sized to provide the air volume and air velocity necessary to keep the duct interior clean and free of residual material.”

Chairperson Moure-Eraso said, “A national combustible dust standard would include requirements to conform to what are now largely voluntary industry guidelines and would go far in preventing these dust explosions.”

The report cites gaps in New Jersey’s regulatory system, noting the state’s Uniform Construction Code Act has adopted the International Building Code (which references NFPA dust standards) but has also exempted “manufacturing, production and process equipment.”  A proposed CSB recommendation to New Jersey’s Department of Community Affairs calls on the regulatory agency to revise the state’s administrative code to remove this exemption so that dust handling equipment would be designed to meet national fire code requirements.  The state is also urged to implement training for local code officials as local jurisdictions enforce the code, and to promulgate a regulation that requires all occupancies handling hazardous materials to inform the local enforcement agency of any type of construction or installation of equipment at an industrial or manufacturing facility.

Chairperson Moure-Eraso said, “Events leading to this accident began even before the earliest planning stages, when the company failed to properly oversee the design, construction and testing of a potentially hazardous system.  The victims have suffered the consequences.  We hope our recommendations are adopted so that these terrifying industrial dust explosion accidents will stop.”

The CSB is an independent federal agency charged with investigating industrial chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems.

The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Visit our website, www.csb.gov.

For more information, contact Communications Manager Hillary Cohen, cell 202-446-8094 or Sandy Gilmour, Public Affairs, cell 202-251-5496.

“CSB Releases Safety Bulletin on Anhydrous Ammonia Incident near Mobile, Alabama”

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Safety Bulletin Notes Five Key Lessons to Prevent Hydraulic Shock

January 15, 2014, East Rutherford, NJ – Today the U.S. Chemical Safety Board released a safety bulletin intended to inform industries that utilize anhydrous ammonia in bulk refrigeration operations on how to avoid a hazard referred to as hydraulic shock.  The safety lessons were derived from an investigation into a 2010 anhydrous ammonia release that occurred at Millard Refrigerated Services Inc., located in Theodore, View of Cracked Pipe from Millard Investigation Alabama.

The accident occurred before 9:00 am on the morning of August 23, 2010. Two international ships were being loaded when the facility’s refrigeration system experienced “hydraulic shock” which is defined as a sudden, localized pressure surge in piping or equipment resulting from a rapid change in the velocity of a flowing liquid. The highest pressures often occur when vapor and liquid ammonia are present in a single line and are disturbed by a sudden change in volume.

This abnormal transient condition results in a sharp pressure rise with the potential to cause catastrophic failure of piping, valves, and other components – often prior to a hydraulic shock incident there is an audible “hammering” in refrigeration piping. The incident at Millard caused a roof-mounted 12-inch suction pipe to catastrophically fail, resulting in the release of more than 32,000 pounds of anhydrous ammonia.

The release led to one Millard employee sustaining injuries when he fell while attempting to escape from a crane was after it became engulfed in the traveling ammonia cloud.  The large cloud traveled a quarter mile from the facility south toward an area where 800 contractors were working outdoors at a clean-up site for the Deepwater Horizon oil spill. A total of 152 offsite workers and ship crew members reported symptomatic illnesses from ammonia exposure. Thirty two of the offsite workers required hospitalization, four of them in an intensive care unit.

Chairperson Rafael Moure-Eraso said, “The CSB believes that if companies in the ammonia refrigeration industry follow the key lessons from its investigation into the accident at Millard Refrigeration Services, dangerous hydraulic shock events can be avoided – preventing injuries, environmental damage, and potential fatalities.”

Entitled, “Key Lessons for Preventing Hydraulic Shock in Industrial Refrigeration Systems” the bulletin describes that on the day before the incident, on August 22, 2010, the Millard facility experienced a loss of power that lasted over seven hours. During that time the refrigeration system was shut down. The next day the system regained power and was up and running, though operators reported some problems.  While doing some troubleshooting an operator cleared alarms in the control system, which reset the refrigeration cycle on a group of freezer evaporators that were in the process of defrosting. The control system reset caused the freezer evaporator to switch directly from a step in the defrost cycle into refrigeration mode while the evaporator coil still contained hot, high-pressure gas.

The reset triggered a valve to open and low temperature liquid ammonia was fed back into all four evaporator coils before removing the hot ammonia gas. This resulted in both hot, high-pressure gas and extremely low temperature liquid ammonia to be present in the coils and associated piping at the same time. This caused the hot high-pressure ammonia gas to rapidly condense into a liquid.  Because liquid ammonia takes up less volume than ammonia gas – a vacuum was created where the gas had been.  The void sent a wave of liquid ammonia through the piping – causing the “hydraulic shock.”

The pressure surge ruptured the evaporator piping manifold inside one of the freezers and its associated 12-inch piping on the roof of the facility. An estimated 32,100 pounds of ammonia were released into the surrounding environment.

Investigator Lucy Tyler said, “The CSB notes that one key lesson is to avoid the manual interruption of evaporators in defrost and ensure control systems are equipped with password protection to ensure only trained and authorized personnel have the authority to manually override systems.“

The CSB also found that the evaporators at the Millard facility were designed so that one set of valves controlled four separate evaporator coils. As a result, the contents of all four coils connected to that valve group were involved in the hydraulic shock event – leading to a larger, more hazardous pressure surge.

As a result, the CSB notes that when designing ammonia refrigeration systems each evaporator coil should be controlled by a separate set of valves.

The CSB found that immediately after discovering the ammonia release, a decision was made to isolate the source of the leak while the refrigeration system was still operating instead of initiating an emergency shutdown. Shutting down the refrigeration system may have resulted in a smaller release, since all other ammonia-containing equipment associated with the failed rooftop piping continued to operate.

A final key lesson from the CSB’s investigation is that an emergency shutdown should be activated in the event of an ammonia release if a leak cannot be promptly isolated and controlled. Doing so can greatly reduce the amount of ammonia released during an accident.

The CSB is an independent federal agency charged with investigating serious chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems.

The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA. Visit our website, http://www.csb.gov.  For more information, contact public@csb.gov.

“CSB Warns About Danger of Hot Work on Tanks Containing Biological or Organic Material”

CSB

Earlier this month a team of CSB investigators deployed to the Omega Protein facility in Moss Point, Mississippi, where a tank explosion on July 28, 2014, killed a contract worker and severely injured another. Our team, working alongside federal OSHA inspectors, found that the incident occurred during hot work on or near a tank containing eight inches of a slurry of water and fish matter known as “stickwater.”DSCN1166

The explosion blew the lid off the 30-foot-high tank, fatally injuring a contract worker who was on top of the tank. A second contract worker on the tank was severely injured. CSB investigators commissioned laboratory testing of the stickwater and found telltale signs of microbial activity in the samples, such as the presence of volatile fatty acids in the liquid samples and offgassing of flammable methane and hydrogen sulfide.

The stickwater inside of the storage tank had been thought to be nonhazardous. No combustible gas testing was done on the contents of the tank before the hot work commenced.

This tragedy underscores the extreme importance of careful hot work planning, hazard evaluation, and procedures for all storage tanks, whether or not flammable material is expected to be present. Hot work dangers are not limited to the oil, gas, and chemical sectors where flammability hazards are commonplace.

The CSB has now examined three serious hot work incidents—all with fatalities—involving hot work on tanks of biological or organic matter. At the Packaging Corporation of America (PCA), three workers were killed on July 29, 2008, as they were performing hot work on a catwalk above an 80-foot-tall tank of “white water,” a slurry of pulp fiber waste and water.  CSB laboratory testing identified anaerobic, hydrogen-producing bacteria in the tank.  The hydrogen gas ignited, ripping open the tank lid and sending workers tumbling to their deaths.

On February 16, 2009, a welding contractor was killed while repairing a water clarifier tank at the ConAgra Foods facility in Boardman, Oregon. The tank held water and waste from potato washing; the CSB investigation found that water and organic material had built up beneath the base of the tank and decayed through microbial action, producing flammable gas that exploded.

Mixtures of water with fish, potatoes, or cardboard waste could understandably be assumed to be benign and pose little safety risk to workers. It is vital that companies, contract firms, and maintenance personnel recognize that in the confines of a storage tank, seemingly non-hazardous organic substances can release flammable gases at levels that cause the vapor space to exceed the lower flammability limit. Under those conditions, a simple spark or even conducted heat from hot work can prove disastrous.

I urge all companies to follow the positive example set by the DuPont Corporation, after a fatal hot work tragedy occurred at a DuPont chemical site near Buffalo, New York. Following CSB recommendations from 2012, DuPont instituted a series of reforms to hot work safety practices on a global basis, including requirements for combustible gas monitoring when planning for welding or other hot work on or near storage tanks or adjacent spaces.

Combustible gas testing is simple, safe, and affordable. It is a recommended practice of the National Fire Protection Association, The American Petroleum Institute, FM Global, and other safety organizations that produce hot work guidance. Combustible gas testing is important on tanks that hold or have held flammables, but it is equally important—if not more so—for tanks where flammables are not understood to be present. It will save lives.

END STATEMENT

More resources:

http://www.csb.gov/e-i-dupont-de-nemours-co-fatal-hotwork-explosion/

http://www.csb.gov/packaging-corporation-storage-tank-explosion/

http://www.csb.gov/seven-key-lessons-to-prevent-worker-deaths-during-hot-work-in-and-around-tanks/

http://www.csb.gov/motiva-enterprises-sulfuric-acid-tank-explosion/

CSB Investigation Warns of Dust Explosion Risk at Recycling Facilities

CSB Com Dust Al Solutions 2010

The U.S. Chemical Safety Board (CSB) has released its final report, safety recommendations and accompanying safety video into a fatal combustible dust explosion at the AL Solutions metal recycling facility in New Cumberland, West Virginia.

As presented to the Board for a vote at a public meeting in Charleston, the report reiterates a recommendation that the Occupational Safety and Health Administration (OSHA) promulgate a general industry combustible dust standard, which CSB said it has been calling for since its 2006 study on these preventable accidents.

The December 9, 2010 accident at the AL Solutions metal recycling facility, which milled and processed scrap titanium and zirconium metal, killed three employees and injured a contractor.

The CSB said that the incident is one of nine serious combustible dust incidents investigated by the CSB since 2003. These explosions and fires caused 36 deaths and 128 injuries.

According to the CSB’s report, most solid organic materials, as well as many metals, will explode if the particles are small enough, and they are dispersed in a sufficient concentration within a confined area, near an ignition source.

The report emphasised to industry that even seemingly small amounts of accumulated combustible dust can cause catastrophic damage.

The CSB investigation determined that AL Solutions experienced a history of fatal dust fires and explosions.

A newly developed CSB safety video entitled ‘Combustible Dust: Solutions Delayed’ details the process of milling and blending metal powder at the facility which was then pressed into dense disk called ‘compacts’.

“The CSB learned that the AL Solutions facility had fatal fires and explosions involving metal dust in 1995 and 2006 in addition to the 2010 explosion. Also, from 1993 until the accident in 2010, there were at least seven fires that required responses from the local fire department,” explained investigator Mark Wingard.

Around 1:20 pm on 9 December 2010, CSB said that a spark or hot-spot from the blender likely ignited the zirconium powder inside. The resulting flash fire lofted the metal dust particles in the blender, forming a burning metal dust cloud.

The cloud ignited other combustible dust within the production building, causing a secondary explosion that ripped through the plant, killing three workers and injuring a contract employee.

“Preventable combustible dust explosions continue to occur, causing worker deaths and injuries. The CSB believes it is imperative for OSHA to  issue a comprehensive combustible dust standard for general industry with clear control requirements to prevent dust fires and explosions,” commented chairperson Rafael Moure-Eras.

In presenting the findings of the case study, CSB’s lead investigator, Johnnie Banks, said: “As the metals were broken down during milling, the risk of a metal dust fire or explosion increased as the metal particles decreased in size.

“At AL Solutions a metal blender used to process zirconium was having mechanical problems that had not been adequately repaired. As a result, the blender was producing heat or sparks due to metal-to-metal contact.”

Investigator Wingard added: “The National Fire Protection Association Standard for Combustible Metals, called NFPA 484, recommends specific practices for controlling metal dust, but AL Solutions did not voluntarily follow those guidelines, and there are no federal OSHA standards to enforce similar requirements.

“In its 2006 Combustible Dust Hazard Study, the CSB recommended that OSHA issue a combustible dust standard for general industry based on the current NFPA guidelines.”

The CSB’s report and video encourage industry to take action to prevent combustible dust incidents.  In July 2013, the CSB identified its 2006 recommendation to develop a combustible dust standard as the first issue in its ‘Most Wanted Chemical Safety Improvement’ outreach program.

According to Moure-Eraso, had a national standard for combustible dust been in place in 2006 – and if industry had followed the requirements – many of the severe dust incidents that followed, including AL Solutions, may have been prevented.

“The time is now for OSHA to take action to prevent these tragic accidents,” he urged.

The CSB is an independent federal agency charged with investigating industrial chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate.

AL Solutions Fatal Dust Explosion
FINAL REPORT: AL Solutions
Location: New Cumberland, WV
Accident Occurred On: 12/09/2010
Final Report Released On: 07/16/2014
Accident Type: Combustible Dust Explosion and Fire
Company Name: AL Solutions
Accident Description
An explosion ripped through the New Cumberland A.L. Solutions titanium plant in West Virginia on December 9, 2010, fatally injuring three workers. The workers were processing titanium powder, which is highly flammable, at the time of the explosion.

Investigation Status
The CSB’s final report was approved 2-0 at a public meeting in Charleston, WV.

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