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UNITED STATES
DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
Metal and Nonmetal Mine Safety and Health

Report of Investigation

Surface Non-Metal Mine
(Sand and Gravel)

Fatal Other (Drowning) Accident
November 9, 2001

Durbin Plant
CalMat Co
Irwindale, Los Angeles County, California
ID No. 04-01734

Accident Investigators

John D. Pereza
Mine Safety and Health Inspector

Harvey Brooks
Mine Safety and Health Inspector

Christopher J. Kelly
Civil Engineer

Isabel R. Williams
Mine Safety and Health Specialist

Originating Office
Mine Safety and Health Administration
Western District
2060 Peabody Road, Suite 610
Vacaville,CA 95687
Lee D. Ratliff, District Manager


OVERVIEW

On November 9, 2001, John Garcia, plant conveyor-man was fatally injured when he drowned after falling into the dredge lake while he and another employee were doing clean up in the area with a water hose.

The accident occurred because hazards related to the task had not been properly evaluated. Neither man was wearing a life jacket, which contributed to the severity of the injuries.

Garcia had 15 years of mining experience, and had been at this plant for 10 months. He had received training in accordance with 30 CFR Part 46.

GENERAL INFORMATION

The Durbin Plant, a surface sand and gravel mine operated by CalMat Co., a subsidiary of Vulcan Materials Company, was located in Irwindale, Los Angeles County, California. Principal operating officials were J. W. Smack, president, Denny Robinson, plant manager, and Brian Oulette, plant foreman. The mine operated two, eight-hour shifts, five days a week. Total employment was 31 persons.

Sand and gravel was extracted by dredge from the bottom of a 70-acre lake located on the mine site. Material was transported from the dredge to land using a series of conveyor belts. The belts, like the dredge, floated on pontoons. The material was transferred by overland conveyors to the main plant where the material was crushed and sized. The finished product was used in the construction industry.

The last regular inspection was conducted on July 11, 2001. Another inspection was conducted following the accident investigation.

DESCRIPTION OF THE ACCIDENT

On the day of the accident, John Garcia (victim) reported for work at 4:30 a.m., his regular starting time. At about 8:30 a.m., Kirk Herrick, foreman, directed Garcia and another employee, Clay Hall, to clean up spillage under the tail section of the Number 11 conveyor (water to land conveyor). Spillage of fines accumulated in this area on a regular basis and was normally cleaned one or two times a week using a high pressure water hose. The water was supplied from a water truck. At about 9:00 a.m., Hall finished filling the water truck and met Garcia at the tail section of the number 11 belt. The two men took turns using the hose to wash fines from under the belt without incident.

Hall was using the hose when Herrick arrived. Herrick instructed Garcia to wash down an additional area under the conveyor at the edge of the bank. When Herrick left, the men completed washing the fines from under the belt and then began to wash away the material from the bank.

Hall, who was standing about three feet from the bank using the hose, stumbled, lost his footing and fell into the water. Garcia, attempting to assist Hall, fell into the water himself. John Sprein, dredge operator, was working several hundred feet away and observed the incident. He radioed for help and ran to the scene where he found Hall still in the water clinging to a pipe that ran along the bottom of the water to land conveyor. He did not see Garcia. Herrick and Denny Robinson, plant manager, arrived and searched the water for Garcia. Rescue divers from the Los Angeles County Sheriff's Department found the victims body several hours later in about forty feet of water. Death was attributed to drowning.

INVESTIGATION OF THE ACCIDENT

MSHA was notified of the accident at 10:10 a.m., on November 9, 2001, by a telephone call from Steve Hopkins, safety and health specialist for Vulcan Materials Company to Ramona Broadnax, western district secretary. An investigation was started on the same day. An order was issued pursuant to Section 103(k) of the Mine Act to ensure the safety of the miners. MSHA's accident investigation team traveled to the mine, conducted an inspection of the accident site, interviewed a number of persons, and reviewed appropriate training records and work procedures. The miners did not request, nor have, representation during the investigation.

DISCUSSION

  • The accident occurred on the shore of the dredge lake, 23 feet from the tail section of the water to land conveyor, where the conveyor met the shoreline. The men had been working on the west side of the conveyor.

  • The water to land conveyor was the last in a series of floating conveyors that transported sand and gravel from a floating dredge to a land conveyor. The land conveyor transported the sand and gravel to the plant for processing. Total production was two and one-half million tons per year.

  • The floating dredge was equipped with dual 20-yard clamshell type buckets, which picked up raw material from the lake bottom.

  • The dredge lake was a 70-acre body of water with depths up to 95 feet. The height of the bank at the location of the accident was measured at 5 feet 6 inches above the water. The bank extended vertically out of the water about one foot then sloped away from the water, to the top edge of the bank at an angle of 35-40 degrees. The slope of the bank below the water line was nearly vertical to the depth of seven feet. The bottom descended away from the bank at a slope of approximately 1.5 horizontal : 1 vertical, to the measured depth of 35 feet (see elevation view, appendix C).

  • The dampness of the dredged material caused fine particles to stick to the belt. A 'drip pan' had been attached to the underside of the tail section on the water to land conveyor to catch any material carried over on the belt's return. The material had slid off the drip pan and formed a sand pile under the belt, several feet away from the tail pulley. The sand pile consisted of fairly uniform fine to medium grained sand. It was this sand employees normally washed away once or twice a week. The sand could be washed away with the high-pressure hose from a distance of 20 feet.

  • The dredge had been moved the night before causing the belt to move about 15 feet west of its previous location. Remnants of an old berm, created some years ago, were on the west side of the water to land conveyor at its new location. Due to the relocation of the belt, the berm had been rubbing on the conveyor frame. Since it floated on the water, the water to land conveyor could move up to five feet in either direction depending on the wind. This movement could have caused damage to the conveyor frame had it continually contacted the berm. The two men had eliminated the berm and had continued washing down the edge of the natural bank to facilitate cleaning future sand spillage.

  • The natural material along the bank in this area was reported to be part of the original mineral deposit, not re-deposited fill. It was well compacted and not easily washed away. There was no evidence of the berm remaining at the time of the investigation.

  • The ground where the accident occurred was fairly level with some baseball sized rocks in the area. Due to the use of the water hose the area was wet. A witness stated the soil in the area was not slippery, and there had been no collapse of ground under his feet. The soil in this area appeared to have been disturbed by rescue activities, however no formations indicating slope failure were observed on the top edges or face of the bank.

  • Water had been supplied from a 3,800-gallon tank mounted on a Peterbilt truck. Pressure was developed by a 9-inch diameter, 15 horsepower Berkeley pump also mounted on the truck. The men had emptied one tank of water and were on the second tank when the accident occurred. It usually took about 45 minutes to drain the tank using a one and one-half inch hose.

  • The hose involved was one and one-half inch in diameter and was equipped with a ten inch tapered nozzle. The discharge opening was one-half inch in diameter. The nozzle end of the hose had been whipping about when the dredge operator and foreman arrived at the scene after the accident. The nozzle had not been equipped with a shut-off valve.

  • There was no visible damage to the victim's hard hat. It was found floating in the water.

  • The dredge operator had tried to radio the two men just prior to the accident to alert them that they may have been too close to the bank. The men never acknowledged the call, possibly due to noise from machinery in the area.

  • The first man to fall into the water had been about three to four feet from the edge when he stumbled. He stated that losing his balance combined with the force from the pressure in the hose had caused him to fall into the water.

  • Neither of the individuals involved were wearing life jackets, which were available.

  • The men were wearing steel-toed boots. Although the victim knew how to swim, he was not a strong swimmer. The added weight of wet clothing was a contributing factor.

  • The surface water temperature the day of the accident was 70 degrees F.

  • Company officials had not performed risk assessments of the task being performed, nor had mine personnel recognized these hazards in relation to doing this task.

    CONCLUSION

    The root cause of the accident was the failure to identify the hazards associated with the task so that safe job procedures could be implemented. Failure to wear life jackets contributed to the severity of the injuries.

    ENFORCEMENT ACTIONS

    CalMat Co

    Order No. 6333375 was issued November 9, 2001 under the provisions of Section 103(k) of the Mine Act:
    A fatal accident occurred at this operation on November 9, 2001, when a conveyor-man drowned in the dredge lake. This order is issued to assure the safety of persons at this operation and prohibits any work in the affected area until MSHA determines that it is safe to resume normal operations as determined by an authorized representative of the secretary of labor. The mine operator shall obtain approval from an authorized representative for all actions to recover and/or restore operations in the affected area.
    Order No. 6333375 was terminated on November 29, 2001. Conditions that contributed to the accident no longer exist and normal mining operations can resume.

    Citation No. 633377 was issued on November 23, 2001 under the provisions of Section 104a of the Mine Act for a violation of 30 CFR 56.15020:
    A fatal accident occurred at this operation on November 9, 2001, when a conveyor-man drowned. The conveyor-man and a co-worker were using a high pressure water hose to remove material spillage under a conveyor structure. Prior to the accident, the co-worker was positioned near the edge of the embankment and fell into the water. The victim attempted to help his co-worker and fell into the water and drowned. Life jackets were not being worn.
    The citation was terminated on November 11, 2001. Company employees were re-trained in the use of life jackets when working near water.

    Related Fatal Alert Bulletin:
    Fatal Alert Bulletin Icon FAB01M27

    APPENDIX A


    Persons Participating in the Investigation

    CalMat Co.(Vulcan Materials)
    Kirk Herrick ............... foreman
    Stephen Hopkins ............... safety and health specialist
    Cynthia Kirby ............... manager of safety, health and environmental
    Brian Oulette ............... plant foreman
    Denny Robinson ............... plant manager
    State of California
    Department of Industrial Relations
    Division of Occupational Safety and Health
    Pete Dizon ............... senior engineer
    James Wittry ............... associate engineer
    O'Melveny & Myers LLP
    Scott Dunham ............... attorney at law
    Mine Safety and Health Administration
    John D. Pereza ............... mine safety and health inspector
    Harvey Brooks ............... mine safety and health inspector
    Christopher J. Kelly ............... civil engineer
    Isabel R. Williams ............... mine safety and health specialist (training)
    APPENDIX B


    Persons interviewed during the investigation

    CalMat Co
    John Sprein ............... dredge operator
    Clay Hall ............... truck driver
    Kirk Herrick ............... mine foreman
    James Hopcus ............... dredge operator
    Paul Versteeg ............... mechanic