Skip to Main Content

An independent federal agency investigating chemical accidents to protect workers, the public, and the environment.

Text Size AA
PRINT PAGE
 

Follow Us

YouTube Facebook Twitter
 

Email Sign-up



statistics

Total # of Recommendations
16
Total # of Open Recommendations
10
Total # of Closed Recommendations
6
Total % of Open 62 vs. Closed 38

Documents

   
Feb 27, 2017 PDF Document Response to Public Comments - CSB Responses to Public Comments
Aug 11, 2016 PDF Document CSB Safety Alert: Preventing High Temperature Hydrogen Attack (HTHA) - Related Safety Bulletin
The CSB’s investigation into the catastrophic failure of a forty-year-old heat exchanger at the Tesoro Refinery determined that the fatal explosion and fire was caused by a damage mechanism known as high temperature hydrogen attack, or HTHA, which severely cracked and weakened the carbon steel heat exchanger over time, leading to a rupture. The CSB’s report released in May 2014 concluded that the standard industry uses for determining vulnerability of equipment to HTHA is inadequate. To address its findings, the CSB made recommendations intended to prevent HTHA to the industry group that issues guidance on HTHA, the American Petroleum Institute (API). Because of these noted deficiencies, the Board voted on July 13, 2016, to designate the Recommendation 2010-08-I-WA-R10 with the status of Closed – Unacceptable Action. In the absence of industry guidance that incorporates findings from the Tesoro Anacortes failure, the CSB is issuing a safety alert to provide additional direction for industry.
May 02, 2014 PDF Document Final Investigation Report - Final Report
Mar 06, 2014 PDF Document Rafael Moure-Eraso Written Senate Testimony 3.6.14 - Congressional Testimony
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198,_TESORO_6600E_HEAT_EXCHANGER_E_SUMMARY_OF_THE_RESULTS__PART_6600-E_HEAT_EXCHANGER_E,_ALL_PARTS,_DAMAGE_DEPTH_AND_PART_17_MOUNTS_RE_(1)
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198,_TESORO_LS2_AND_LS2CS2_TEE_FINDINGS_PART_6600E_HEAT_EXCHANGER,_LS2_22_IN,_LS2_T2L_SEM_FRACTOGRAPHY_AND_PART_22_LS2-CS2_TEE
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198-_LS3_TOP_PART_6600-E_HEAT_EXCHANGER_LS_3_TOP_PART_15_Part 5
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198-_LS3_TOP_PART_6600-E_HEAT_EXCHANGER_LS_3_TOP_PART_15_Part 4
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198-_LS3_TOP_PART_6600-E_HEAT_EXCHANGER_LS_3_TOP_PART_15_Part 3
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
ETA_LAB_NO.M10198-_LS3_TOP_PART_6600-E_HEAT_EXCHANGER_LS_3_TOP_PART_15_Part 2
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198-_LS3_TOP_PART_6600-E_HEAT_EXCHANGER_LS_3_TOP_PART_15_Part 1
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10329,_TESORO_EXCHANGER_E6600B_EXAMINATION_DATA_PARTS_6600B_HEAT_EXCHANGER,_PARTS_1B,_2B,_AND_3B
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10329-B,_TESORO_EXCHANGER_E6600-B_EXAMINATION_DATA_PARTS_E6600B_HEAT_EXCHANGER,_PARTS_1B,_4B,_AND_5B
Feb 18, 2014 PDF Document Beta Laboratory Reports (Appendix H) - Beta Laboratory Reports (Appendix H)
BETA_LAB_NO.M10198-_CS4-02_PART_6600-E_HEAT_EXCHANGER_CS4_PART_19___20_Part 4
Results: 55 Records found.
 
 
© csb.gov. All rights reserved