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Accident # | 147603 |
State Police # | 13-25112 |
Accident Date | 2013-03-25 |
Report Date | 2013-03-28 |
Follow-up Date | 2013-05-22 |
Follow-up: | Yes |
Pollutant | Duration | Point Source | Greenhouse Gas | Criteria Pollutant | Ozone forming chemical | Amount of Release |
Sulfur Dioxide | 40 M | Unit 259 North Ground Flare | NO | YES | NO | 3,385.0 pounds |
Methane | 40 M | Unit 259 North Ground Flare | YES | NO | YES | 1.5 pounds |
Ethane | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 21.6 pounds |
Ethylene | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 0.4 pounds |
Propane | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 74.3 pounds |
Propylene | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 1.5 pounds |
n-Butane | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 54.6 pounds |
Isobutane | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 22.2 pounds |
1-Butene | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 0.4 pounds |
trans-2-Butene | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 1.2 pounds |
cis-2-Butene | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 0.1 pounds |
n-Pentane | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 6.6 pounds |
Pentene Plus | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 1.7 pounds |
Carbon Dioxide | 40 M | Unit 259 North Ground Flare | YES | NO | NO | 215.8 pounds |
Carbon Monoxide | 40 M | Unit 259 North Ground Flare | NO | YES | NO | 79.4 pounds |
Hydrogen | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 0.0 pounds |
Nitrogen | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 0.3 pounds |
Hydrogen Sulfide | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 36.7 pounds |
NOx | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 14.6 pounds |
Volatile Organic Compounds (VOCs) | 40 M | Unit 259 North Ground Flare | NO | NO | YES | 168.6 pounds |
Particulate Matter 10 | 40 M | Unit 259 North Ground Flare | NO | YES | NO | 1.6 pounds |
Particulate Matter 2.5 | 40 M | Unit 259 North Ground Flare | NO | YES | NO | 1.6 pounds |
Highly Reactive Volatile Organic Compounds (HRVOCs) | 40 M | Unit 259 North Ground Flare | NO | NO | NO | 1.9 pounds |
Accident Classified As: Reportable Quantity
The two root causes identified were the benzene stripper lower level controller malfunctioned and the operator did not have sufficient response time. On March 25, 2013 the Unit 210 Crude Overhead Compressor shut down at 18:03 hours and was restarted at 18:26 hours. A second shutdown occurred at 19:23 hours and was re-started at 19:41 hours. The duration of Unit 210 venting to the North Ground Flare was 40 minutes. Approximately 3,385 pounds of sulfur dioxide were released (above the reportable quantity of 500 pounds). On March 25, 2013 at 17:45 hours, issues developed in the Unit 210 Desalter vessels. As a result of the event, liquid was carried over from the Desalters to downstream Unit 210 vessels. Eventually, liquid filled the Unit 210 Overhead Compressor Feed Knockout drum which shut down the Overhead Compressor. The ambient air monitoring stations located by the ground flares did not detect a significant increase in sulfur dioxide emissions.
The results of the Root Cause Analysis will determined the event was preventable.
Liquid was drained from the Unit 210 Crude Overhead Compressor Feed Knockout Drum. The Unit 210 Crude Overhead Compressor was re-started. While sulfur dioxide was the only chemical released above reportable quantity, NOx, monoxide, VOCs, PM10, PM2.5,HRVOCs, and hydrogen sulfide were released over the permit limit. An accident investigation was conducted to determine the cause(s) of the incident. The two root causes identified were 1. Equipment difficulty, design, problem not anticipated (Benzene stripper lower level controller malfunctioned); and 2. human engineering, non-fault tolerant system, errors not recoverable (operator did not have sufficient response time). The following recommendations will be implemented: 1. redesign or upgrade the benzene stripper level indicator 210L10197 to provide backup level indication for 210LC0187 due 12/20/13; 2. add soft stops to 210L1097 to limit flow from the 1st stage Desalter to the Benzene Stripper- complete; and 3. evaluate the hydraulics of the Benzene Stripper bottoms circuit and consider developing a project to eliminate constraints in the system- due 12/20/13.
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