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Safety Recommendation Details

Safety Recommendation I-90-005
Details
Synopsis: ABOUT 11:30 A.M., ON NOVEMBER 30, 1988, A TRACTOR-FLATBED SEMITRAILER OPERATED BY HY YIELD BROMINE COMPANY OVERTURNED AT THE INTERSECTION OF TWO FARM ROADS IN A SPARSELY POPULATED AREA OF COLLIER COUNTY, FLORIDA. THE SEMITRAILER WAS LOADED WITH 32 CYLINDERS OF A POISONOUS AND TOXIC BY INHALATION MIXTURE, 98 PERCENT METHYL BROMIDE AND 2 PERCENT CHLOROPICRIN. ELEVEN OF THE CYLINDERS WERE FULL, EACH CONTAINING ABOUT 1,500 POUNDS OF THE POISONOUS MIXTURE, AND THE REMAINDER OF THE CYLINDERS WERE PARTIALLY FULL OR EMPTY EXCEPT FOR RESIDUE. THE DRIVER HAD COMPLETED THE SECOND OF FOUR SCHEDULED STOPS WHEN THE ACCIDENT OCCURRED.
Recommendation: THE NTSB RECOMMENDS THAT THE RESEARCH AND SPECIAL PROGRAMS ADMINISTRATION: REQUIRE ALL MANUFACTURERS OF DEPARTMENT OF TRANSPORTATION (DOT) SPECIFICATION CONTAINERS THAT WERE NOT TESTED AND INSPECTED IN ACCORDANCE WITH REGULATORY REQUIREMENTS, AND ALL THAT WERE PROPERLY TESTED BUT THAT FAILED TO MEET REGULATORY REQUIREMENTS TO RETEST RANDOMLY SELECTED CONTAINERS FROM EACH LOT OF THESE IDENTIFIED CONTAINERS IN ACCORDANCE WITH DOT REGULATORY PROCEDURES; AND TO NOTIFY THE OWNERS OF CONTAINERS IN LOTS THAT FAIL THE TESTS TO REMOVE DOT SPECIFICATION MARKINGS.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Acceptable Alternate Action
Mode: Intermodal
Location: Collier County, FL, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA89MZ001
Accident Reports: ​Puncture of a Cylinder Containing a Mixture of Methyl Bromide and Chloropicrin Following the Overturn of a Tractor/Semitrailer
Report #: HZM-90-01
Accident Date: 11/30/1988
Issue Date: 3/23/1990
Date Closed: 10/4/1995
Addressee(s) and Addressee Status: RSPA (Closed - Acceptable Alternate Action)
Keyword(s): Hazmat

Safety Recommendation History
From: NTSB
To: RSPA
Date: 10/4/1995
Response: THE BOARD NOTES THAT RSPA, IN RESPONDING TO THESE TWO RECOMMENDATIONS, HAS DEVELOPED FORMAL PROCEDURES FOR EXAMINING & TESTING CONTAINERS THAT DO NOT COMPLY WITH DOT SPECIFICATIONS & FOR ANALYZING RESULTS TO DETERMINE THE RISK ASSOCIATED WITH THE AREAS OF NONCOMPLIANCE. DEPENDING ON THE LEVEL OF RISK INVOLVED, RSPA INTENDS TO REMOVE THESE CONTAINERS FROM SERVICE OR TAKE SOME ACTION TO REMOVE THE HAZARD, SUCH AS RETROFITTING, DERATING, OR REQUIRING ADDITIONAL OPERATIONAL CONTROLS. WHILE THESE PROCEDURES DO NOT REQUIRE STRICT COMPLIANCE WITH FEDERAL REGULATIONS, RSPA'S FOCUS ON ENSURING THE SAFETY OF DOT SPECIFICATION CONTAINERS THROUGH EXAMINATION, TESTING, & RISK ANALYSIS MEETS THE INTENT OF THESE RECOMMENDATIONS. THEREFORE I-90-5 & -6 ARE CLASSILFIED "CLOSED--ACCEPTABLE ALTERNATE ACTION."

From: RSPA
To: NTSB
Date: 7/28/1995
Response: RSPA HAS DEVELOPED A FORMAL WRITTEN PROCEDURE REGARDING REMOVAL OF HAZARDOUS MATERIALS PACKAGINGS FROM SERVICE THAT WERE NOT PROPERLY TESTED OR FAILED REQUIRED TESTS. IT SETS FORTH THE ACTIONS TO BE FOLLOWED DEPENDING UPON WHICH OF THE FOLLOWING HAZARDS OR RISKS ARE INVOLVED: 1) AN IMMINENT HAZARD WHERE THERE IS A SUBSTANTIAL PROBABILITY THAT DEATH OR SERIOUS INJURY WILL OCCUR, 2) LESSER HAZARD WHERE NO SERIOUS INJURIES OR WIDESPREAD PROPERLY DAMAGE WOULD BE INVOLVED, OR 3) A SITUATION WHERE A VERY MINIMAL OR NO HAZARD EXISTS. THE PROCEDURE ALSO IDENTIFIES THE FACTORS THAT MUST BE EXAMINED WHEN ASSESSMENTS OF HAZARD, RISK, RECALL, & SAFETY ARE INVOLVED. BRIEFLY, THE FORMAL PROCEDURE DEFINES "IMMINENT HAZARD" AS A DEFECT THAT PRESENTS A "SUBSTANTIAL PROBABILITY THAT DEATH OR SERIOUS INJURY WILL OCCUR FROM FREQUENT WORKER OR PUBLIC EXPOSURE & FREQUENT PACKAGING FAILURES. AN IMMINENT HAZARD REQUIRES IMMEDIATE PUBLIC NOTIFICATION OF THE HAZARD & INITIATION OF ACTIONS TO ELIMINATE OR AMELIORATE THE IMMINENT HAZARD." RSPA WILL REQUIRE INDIVIDUALS THAT MANUFACTURE PACKAGINGS THAT PRESENT IMMINENT HAZARD." RSPA WILL REQUIRE INDIVIDUALS THAT MANUFACTURE PACKAGINGS THAT PRESENT IMMINENT HAZARDS TO "REMOVE THE PACKAGINGS FROM SERVICE OR OTHER ACTION TO AMELIORATE THE HAZARD PRESENTED BY THE SUSPECT PACKAGINGS." RSPA DEFINES "VERY MINIMAL OR NO HAZARD" AS "A VARIATON OF 5% OR LESS FROM VALUES FOR MATERIAL PROPERTIES, TEST CONDITIONS, ACCEPTANCE CRITERIA, MINIMUM WALL THICKNESS, OR MARKED VALUES." RSPA WILL TAKE NO ACTION, OTHER THAN ENFORCEMENT ACTION, ON INDIVIDUALS THAT MANUFACTURE NONCONFORMING HAZARDOUS MATERIALS PACKAGINGS THAT PRESENT "VERY MINIMAL OR NO HAZARD." BETWEEN THOSE TWO DEFINITIONS ARE THE PACKAGINGS THAT PRESENT A "LESSER HAZARD." RSPA WILL REQUIRE INDIVIDUALS THAT MANUFACTURE PACKAGINGS THAT PRESENT A "LESS HAZARDD" TO "TAKE APPROPRIATE & TIMELY CORRECTIVE ACTION THAT MAY INCLUDE ADDITIONAL ANALYSIS &/OR TEST..." & MAY INVOLVE REMOVAL OF PACKAGING FROM SERVICE, RETROFITTING, DERATING, & OPERATIONAL CONTROLS. RSPA REQUESTED THAT THE SR BE CLASSIFIED "CLOSED--ACCEPTABLE ALTERNATIVE ACTION."

From: NTSB
To: RSPA
Date: 7/8/1994
Response: THE BOARD NOTES THAT RSPA, IN RESPONDING TO THESE TWO RECOMMENDATIONS, IS DEVELOPING WRITTEN PROCEDURES PERTAINING TO DOT SPECIFICATION CONTAINERS THAT WERE NOT PROPERLY TESTED OR FAILED REQUIRED TESTS, & GUIDELINES CONCERNING THE RECALL OF CYLINDERS DEEMED TO POSE A SERIOUS SAFETY HAZARD. WE BELIEVE THAT THESE ARE POSITIVE ACTIONS, & REQUEST THAT COPIES OF THESE PROCEDURES & GUIDELINES BE PROVIDED WHEN THEY ARE ARE COMPLETED. HOWEVER, THE BOARD IS CONCERNED WITH RSPA'S POSITION THAT IT IS NOT NECESSARY TO REQUIRE THE TESTING OF RANDOMLY SELECTED CONTAINERS FROM LOTS THAT WERE IMPROPERLY TESED OR FAILED THE REQUIRED TESTS AS RECOMMENDED BY I-90-5, & THAT IT IS NOT NECESSARY TO RECALL & REMOVE CONTAINERS THAT FAIL TO MEET SPECIFICATION REQUIREMENTS, AS RECOMMENDED BY I-90-6. WITHOUT RSPA'S STRICT ENFORCEMENT OF TESTING & OTHER SPECIFICATION REQUIREMENTS, THE INTEGRITY OF ANY DOT SPECIFICATION CONTAINER IS QUESTIONABLE BECAUSE THERE IS NO ASSURANCE THAT THE CONTAINER MEETS THE MINIMUM REQUIREMENTS FOR STRENGTH & INTEGRITY. RSPA HAS THE RESPONSIBILITY TO ENSURE THAT CYLINDERS & OTHER CONTAINER MARKED AS DOT SPECIFICATION CONTAINERS MEET ALL MINIMUM SAFETY REQUIREMENTS, INCLUDING THOSE FOR TESTING & INSPECTION, BEFORE THEY ARE USED FOR THE TRANSPORTATION OF HAZARDOUS MATERIALS. THE BOARD AGAIN ENCOURAGES RSPA TO PROHIBIT THE TRANSPORTATION OF HAZARDOUS MATERIALS IN CONTAINERS THAT FAIL TO MEET THE DOT SPECIFICATION, INCLUDING THOSE CONTAINERS THAT HAVE NOT BEEN PROPERLY & SUCCESSFULLY TESTED IN ACCORDANCE WITH DOT REQUIREMENTS. PENDING RSPA'S RESPONSE, I-90-5 & -6 ARE CLASSIFIED "OPEN--UNACCEPTABLE RESPONSE."

From: RSPA
To: NTSB
Date: 5/3/1994
Response: AS RECOMMENDED BY NTSB IN THEIR RESPONSE TO RSPA'S PROPOSED ACTION, A DRAFT OF WRITTEN PROCEDURES IS BEING DEVELOPED WHICH WILL FORMALIZE & STRENGTHEN THE PROCESS OF DEALING WITH DOT SPECIFICATION PACKAGINGS THAT WERE NOT TESTED, WERE IMPROPERLY TESTED, OR FAILED REQURIED TESTS. RSPA HAS ALWAYS ASSESSED THE SAFETY IMPLICATION OF NON-COMPLIANCE & ACTED QUICKLY WHEN SAFETY WAS AFFECTED. THEREFORE, WE SEE NO NEED TO RETROACTIVELY EVALUATE PAST ACTIONS AS PROPOSE BY NTSB. WE EXPECT TO FORMALIZED THE WRITTEN PROCEDURES IN THE NEAR FUTURE & WILL KEEP YOU APPRISED OF OUR ACTIONS.

From: NTSB
To: RSPA
Date: 6/21/1993
Response: OUR RECORDS SHOW THAT WE HAVE NOT RECEIVED ANY FURTHER RESPONSE FROM THE RSPA REGARDING THESE RECOMMENDATIONS. WE WOULD APPRECIATE BEING INFORMED ABOUT EFFORTS THAT HAVE BEEN OR ARE BEING MADE TO IMPLEMENT THESE RECOMMENDATIONS.

From: NTSB
To: RSPA
Date: 12/13/1990
Response:

From: RSPA
To: NTSB
Date: 9/24/1990
Response: RSPA WILL FORMALIZE AND STRENGTHEN ITS EXISTING PRACTICES FOR DEALING WITH SITUATIONS IN WHICH IT DISCOVERS THAT DOT SPECIFICATION OR EXEMPTION PACKAGINGS WERE NOT TESTED, FAILED REQUIRED TESTS, OR OTHERWISE DO NOT MEET THAT APPLICABLE REGULATORY OR EXEMPTION REQUIREMENTS. UNDER THESE WRITTEN PROCEDURES, THE FOLLOWING ACTIONS WILL BE TAKEN. WHEN NONCOMPLYING PACKAGES ARE DISCOVERED DURING INSPECTIONS OR INVESTIGATIONS, THE CHIEF OF THE ENFORCEMENT DIVISION PROMPTLY WILL CONFER WITH THE CHIEF OF THE TECHNICAL DIVISION, AND THE CHIEF OF THE EXEMPTIONS AND APPROVALS DIVISION WHEN AND EXEMPTION OR APPROVAL IS INVOLVED. THEY WILL DISCUSS THE AVAILABLE INFORMATION, OBTAIN ANY NECESSARY ADDITIONAL INFORMATION, AND DETERMINE WHICH ONE OR MORE OF THE FOLLOWING COURSES OF ACTION IS APPROPRIATE: 1. IF THEY DETERMINE THAT AN "IMMINENT HAZARD" EXISTS, IMMEDIATELY REQUEST THE APPARENT VIOLATOR TO TAKE APPROPRIATE AND TIMELY CORRECTIVE ACTION (E.G., PACKAGING RECALL OR DESTRUCTION). IF SUCH ACTION IS NOT UNDERTAKEN EXPEDITIOUSLY, THEY WILL REQUEST THE CHIEF COUNSEL OF RSPA TO INITIATE APPROPRIATE ACTION UNDER SECTION 111 OF THE HAZARDOUS MATERIALS TRANSPOR- TATION ACT (HMTA). IN ADDITION, WE WILL PUBLISH AN APPROPRIATE NOTICE CONCERNING THE DEFECTIVE PACKAGING IN THE FEDERAL REGISTER IF DEEMED NECESSARY TO PROTECT THE PUBLIC. FINALLY, WE WILL TAKE ADDITIONAL ACTIONS AS DESCRIBED IN THE FOLLOWING PARAGRAPHS AS APPR0- PRIATE. 2. IF WE DETERMINE THAT A LESSER HAZARD EXISTS, WE WILL EXPEDITIOUSLY REQUEST THE APPARENT VIOLATOR TO TAKE APPROPRIATE AND TIMELY CORRECTIVE ACTION. THAT ACTION INCLUDE ADDITIONAL ANALYSIS AND/OR TESTING TO DETERMINE THE NATURE AND EXTENT OF THE PROBLEM, PACKAG- ING RECALL OR RETROFIT, DESTRUCTION, NOTIFICATION TO DISTRIBUTORS OR OTHER RECIPENTS OF THE PACKAGINGS, AND INSTITUATION OF CORRECTIVE ACTIONS TO PREVENT A RECUR- RENCE OF THE PROBLEM. WE ALSO WILL CONSIDER PUBLICA- TION OF A FEDERAL REGISTER NOTICE AND, THROUGH THE CHIEF COUNSEL'S OFFICE, WILL INSTITUTE APPROPRIATE ENFORCEMENT ACTION. THAT ENFORCEMENT ACTION MAY INCLUDE A COMPLIANCE ORDER UNDER SECTION 109 (A) OF THE HMTA OR WITHDRAWAL OF AN EXEMPTION. 3. IF WE DETERMINE THAT NO HAZARD OR ONLY A MINIMAL HAZARD EXISTS, WE WILL, THROUGH THE CHIEF COUNSEL'S OFFICE, INSTITUTE APPROPRIATE CIVIL PENALTY AND/OR COMPLIANCE ORDER ENFORCEMENT ACTION. THAT RECOMMENDATION I-90-05 BE CLASSIFIED AS "OPEN ACCEPTABLE ACTION."