Year: 2016

Tesoro Refinery Fatal Explosion and Fire

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Accident Description
An explosion and fire led to the fatal injury of seven employees when a nearly forty-year-old heat exchanger catastrophically failed during a maintenance operation to switch a process stream between two parallel banks of exchangers at the Tesoro refinery in Anacortes, Washington

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Investigation Status
The CSB’s final report was approved 3-0 at a public meeting on May 1, 2014.

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American Petroleum Institute (API)
Environmental Protection Agency (EPA)
Governor and Legislature of the State of Washington
Tesoro Anacortes Refinery
Tesoro Refining & Marketing Company LLC
USW Local 12-591
Washington State Department of Labor & Industries – Division of Occupational Safety and Health

Silver Eagle Refinery Flash Fire and Explosion and Catastrophic Pipe Explosion

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On the evening of January 12, 2009, 2 refinery operators and 2 contractors suffered serious burns resulting from a flash fire at the Silver Eagle Refinery in Woods Cross, Utah. The accident occurred when a large flammable vapor cloud was released from an atmospheric storage tank, known as tank 105, which contained an estimated 440,000 gallons of light naphtha. The vapor cloud found an ignition source and the ensuing flash fire spread up to 230 feet west of the tank farm. On November 4, 2009, a second accident occurred at the Silver Eagle Refinery in Woods Cross, Utah, when a powerful blast wave –  caused by the failure of a 10 inch pipe – damaged nearby homes.

Hydraulic Shock in Ammonia Incident

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Published on Mar 26, 2015

CSB safety video detailing key lessons for preventing hydraulic shock in ammonia refrigeration systems based on the CSB’s investigation into the accident at Millard Refrigerated Services Inc. on August 23, 2010. 32,000 pounds of anhydrous ammonia were released to the atmosphere, resulting in over thirty offsite workers being hospitalized – four in an intensive care unit.

Massive Explosion at the Caribbean Petroleum Incident

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Published on Oct 21, 2015

CSB Safety Video on the 2009 massive explosion at the Caribbean Petroleum, or CAPECO, terminal facility near San Juan, Puerto Rico. The incident occurred when gasoline overflowed and sprayed out from a large aboveground storage tank, forming a 107-acre vapor cloud that ignited. While there were no fatalities, the explosion damaged approximately 300 nearby homes and businesses and petroleum leaked into the surrounding soil, waterways and wetlands. Flames from the explosion could be seen from as far as eight miles away.