U.S. Fire Administration/Technical Report Series

Conservative Approach to 

Chemical Plant Fire

Ventura County, California

USFA-TR-029/April 1989

U.S. Fire Administration Fire Investigations Program

T

he U.S. Fire Administration develops reports on selected major fires throughout the country. 

The fires usually involve multiple deaths or a large loss of property. But the primary criterion 

for deciding to do a report is whether it will result in significant “lessons learned.” In some 

cases these lessons bring to light new knowledge about fire--the effect of building construction or 

contents, human behavior in fire, etc. In other cases, the lessons are not new but are serious enough 

to highlight once again, with yet another fire tragedy report. In some cases, special reports are developed to discuss events, drills, or new technologies which are of interest to the fire service.

The reports are sent to fire magazines and are distributed at National and Regional fire meetings. The 

International Association of Fire Chiefs assists the USFA in disseminating the findings throughout the 

fire service. On a continuing basis the reports are available on request from the USFA; announcements of their availability are published widely in fire journals and newsletters.

This body of work provides detailed information on the nature of the fire problem for policymakers 

who must decide on allocations of resources between fire and other pressing problems, and within 

the fire service to improve codes and code enforcement, training, public fire education, building 

technology, and other related areas.

The Fire Administration, which has no regulatory authority, sends an experienced fire investigator 

into a community after a major incident only after having conferred with the local fire authorities 

to insure that the assistance and presence of the USFA would be supportive and would in no way 

interfere with any review of the incident they are themselves conducting. The intent is not to arrive 

during the event or even immediately after, but rather after the dust settles, so that a complete and 

objective review of all the important aspects of the incident can be made. Local authorities review 

the USFA’s report while it is in draft. The USFA investigator or team is available to local authorities 

should they wish to request technical assistance for their own investigation.

This report and its recommendations were developed by USFA staff and by TriData Corporation, its staff 

and consultants, who are under contract to assist the USFA in carrying out the Fire Reports Program.

The USFA appreciates the cooperation received from the Ventura County, California Fire Department for 

this report. Particular thanks go to Chief Rand-Scott Coggan and Assistant Chief George E. Lund.

For additional copies of this report write to the U.S. Fire Administration, 16825 South Seton Avenue, 

Emmitsburg, Maryland 21727. The report is available on the Administration’s Web site at http://

www.usfa.dhs.gov/

Conservative Approach to

Chemical Plant Fire

Ventura County, California

Investigated by: J. Gordon Routley

This is Report 029 of the Major Fires Investigation Project conducted

by TriData Corporation under contract EMW-88-C-2649 to the United

States Fire Administration, Federal Emergency Management Agency.

Department of Homeland Security

United States Fire Administration

National Fire Data Center

U.S. Fire Administration

Mission Statement

As an entity of the Department of Homeland 

Security, the mission of the USFA is to reduce life and economic losses due to fire 

and related emergencies, through leadership, advocacy, coordination, and support. 

We serve the Nation independently, in coordination with other Federal agencies, 

and in partnership with fire protection and 

emergency service communities. With a 

commitment to excellence, we provide public education, training, technology, and data 

initiatives.

Table of Contents

OVERVIEW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SUMMARY OF KEY ISSUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

BACKGROUND. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

REGULATORY ACTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

THE FIRE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

LESSONS LEARNED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Appendix A: Site Diagram. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Appendix B: Photographs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

1

Conservative Approach to Chemical Plant Fire

Ventura County, California

April 10, 1989

Local Contacts: Rand-Scott Coggan, Fire Chief

George E. Lund, Assistant Chief

Ventura County Fire Department

395 Willis Avenue

Camarillo, California 93010

OVERVIEW

A fire in a chemical plant in Saticoy, California, destroyed the plant and two adjoining occupancies 

and caused the community’s 1,500 residents to be evacuated for 10 hours on April 10, 1989. Two 

firefighters were treated for exposure to toxic products, and 14 others were evaluated at a hospital 

for potential exposure. Clean-up and decontamination after the fire are expected to cost more than 

two-hundred thousand dollars and involve removal of the entire contents of the plant and recovery 

of runoff and contaminated soil in the surrounding area.

The plant, which prepared chemical ingredients for pharmaceutical companies, had been the subject 

of legal actions resulting from efforts to enforce fire, building, and environmental health regulations. 

A fire inspector and a building safety inspector had been injured in an incident at the plant several 

months earlier when they were exposed to toxic products while conducting an inspection. After 

code enforcement actions had been initiated, the business and property owners had notified the fire 

department that its personnel would not be admitted without a warrant.

The Ventura County Fire Department took an extremely cautious approach to the incident, based on 

prior knowledge of the hazards inside the building. A policy directive had been issued to stay out of 

the building in the event of a fire, because of the known nature of the products involved.

Revised 12/89.
2

SUMMARY OF KEY ISSUES

Issues Comments

Hazardous Chemical Reporting Property had prior history of hazardous materials (Hazmat) incidents.

Business was notified to cease operations in building. Owners refused to admit inspectors 

without a warrant.

Pre-fire plan was to keep firefighters out of building. Well communicated knowledge of 

unknown hazard reduced casualties.

Cause Undetermined.

Wind Shift Decontamination area rendered unusable by wind shift.

Water Runoff Diking and use of minimum water for suppression helped minimize runoff.

Firefighter Health and Safety Crews need guidance on proper protective ensembles for a combination fire and Hazmat 

incident.

Incident Command Worked well during fire, but need to consider turnover of Hazmat scene to civilian agencies 

and need for point-of-contact for press after fire department leaves scene. 

The incident presents a strong case for requiring reporting of hazards for chemical occupancies. It 

also demonstrates the difficulties that are often encountered in attempting to enforce Hazmat code 

requirements. The injuries sustained by personnel operating at the scene were minor, particularly in 

view of the hazards that were encountered.

BACKGROUND

Saticoy is a small, unincorporated community in Ventura County, bordering on the City of Ventura, 

with a population estimated at 1,500. Saticoy has a sector that could be described as a “low grade” 

industrial district, with numerous small businesses, storage yards, and warehouses. Several occupancies in the area use or store Hazmat.

Pacific Intermediates occupied two bays of a multi-tenant building in a private industrial complex. 

The single story structure was divided into 12 bays of approximately 800 square feet each. The 

building was of ordinary construction with block walls and a wood roof structure. The building 

contained no fixed fire protection systems and there were no special features for chemical storage.

The company stored and mixed chemicals which were used as ingredients in drugs manufactured 

by pharmaceutical companies. The production of these ingredients is not regulated by the Food and 

Drug Administration (FDA).

The building housed an estimated 300 different chemicals in quantities ranging from hundreds 

of gallons to a few ounces. The substances included flammable liquids, toxic products, water reactive and photo sensitive chemicals, heavy metals, and corrosives. The interior of the building was 

crowded with chemicals stored in 55 gallon drums and many types of smaller containers, along with 

mixing vats, glassware, and other equipment used to mix and prepare end products for shipment. 

Many of the containers were unlabelled.

Several drums were stored outside the building and in a storage container in the parking area. A 

metal fence behind the container was heavily corroded from vapors escaping from the container or 

the drums stored next to it.
USFA-TR-029/April 1989 3

Fire protection in Saticoy is provided by the Ventura County Fire Department, a career department 

that protects the unincorporated areas of the county and several incorporated cities. An engine 

company provides the first due response to Saticoy on automatic aid. Both the county and city fire 

departments have trained and equipped Hazmat response teams.

Pacific Intermediates had provided information to the county fire department on the types of materials present on the premises, as required by California Hazard Communications regulations. The 

report included several items that were known to be present in bulk quantities, as well as a long list 

of small quantity chemicals. The information supplied would basically comply with the Superfund 

Amendments and Reauthorization Act (SARA) reporting requirements. 

The Ventura County Fire Department distributed copies of the information package to the first due 

battalion, initial response companies, and the Hazardous Incident Response Team. The Ventura City 

engine company that responded to the location received a copy from the battalion chief. A copy was 

retained at fire prevention to be transported to the scene of an incident by an inspector. All hazard 

communications documents are managed in a similar manner.

REGULATORY ACTIONS

Attempts to regulate the hazards at Pacific Intermediates began in August of 1987, when the local 

engine company made a referral to the Division of Fire Prevention, based on the chemical storage 

that was visible outside the building. Following an inspection by a fire prevention inspector and consultation with a building safety inspector, the business owners were notified that they could not carry 

on their nature of business in the type of building they occupied. It was suggested that the company hire a consultant to make an assessment and advise them on appropriate actions. A Notice of 

Violation was issued early in 1988, when the owner failed to respond to the letter of notification.

The chemical company then hired a consultant who determined that it could not meet code requirements in its present premises and advised seeking a new site to relocate. In June of 1988 the owners 

made a verbal commitment to relocate within 6 to 12 months. The owners would not make this 

commitment in writing, and the fire department could not obtain a copy of the consultant’s written 

report. In July, the fire department determined that the company had severed its relationship with 

the consultant and that the consultant’s fee had not been paid.

On July 15, 1988, the fire inspector and a building safety inspector visited the premises to determine 

if any corrective actions had been taken. While on the premises, they encountered a leaking drum 

of vinyl chloride which had been left outside the building, unlabelled, under a plastic sheet. Both 

inspectors had to be transported to an area hospital for treatment of respiratory distress resulting 

from this exposure, and the inspection turned into a 16-hour long Hazmat incident. A private contractor had to be called in to safely remove the leaking container.

A second Notice of Violation was issued against Pacific Intermediates, and the Environmental Health 

and Planning departments became involved in the case. Inspections by these agencies revealed several additional code violations relating to hazardous waste disposal and contamination of the area 

around the premises. The county counsel was consulted, since it appeared that multiple violations 

were involved and the business was resisting enforcement efforts. 

On October 21, 1988, the fire department received a letter from the business, asserting that the fire 

department lacked regulatory jurisdiction and claiming that previous inspections had been made in 

contravention of the owners’ rights, as guaranteed by the Fourth Amendment. Similar letters were 
4

sent by the owners of the property and by another tenant who had been cited for fire code violations. All claimed that they would deny access to any fire department representative who could not 

produce a warrant for entry.

After receiving this letter, the fire department issued a directive to companies to stay outside the 

Pacific Intermediates occupancy in the event of a fire or chemical emergency incident. This action 

was taken on the basis of unknown hazards within the occupancy and the denial of access for inspection or pre-fire planning.

With the active participation of the county counsel, warrants were obtained and inspections were 

made by the fire, environmental health, building safety, and planning departments. Formal charges 

were filed in late November, including 12 fire code violations, felony violations of the hazardous 

waste regulations, and other counts. The cases were still before the courts on the date of the fire, 

having been continued in court. On the day of the fire, the district attorney had obtained a warrant 

for an additional inspection for environmental health requirements.

THE FIRE

At 1803 on Monday, April 10, 1989, the Ventura County Fire Department received a report of smoke 

coming from the Pacific Intermediates occupancy, from the proprietor of an adjoining business. A 

first alarm response of two engine companies, one ladder company, and a battalion chief was dispatched. The first arriving units reported smoke showing, and the Hazmat teams from both Ventura 

County and Ventura City were requested, along with the inspector who had been managing the case. 

Entry was made to the adjoining occupancies to check for fire extension, but not into the chemical 

company.

The incident commander consulted with the Hazmat teams and with the inspector to develop a plan 

of action. Three major concerns were addressed:

• Mixing of chemicals inside the building;

• Airborne products of combustion; and,

• Liquid runoff.

A steady westerly wind of 7 to 8 miles per hour, was blowing the products of combustion into an 

unpopulated area, allowing operations to be set up on the west side of the building. After a detailed 

assessment of the situation, a decision was made to set up for a cautious entry from the upwind side, 

through the south adjoining occupancy, to stop extension in that direction. A decontamination area 

was established, and companies prepared to move in cautiously.

By the time the attack team was ready, the fire had vented through the roof of the building and was 

burning through the wall into the adjoining occupancy. The attack was initiated at 2030 and was 

successful in knocking down most of the visible fire in the Pacific Intermediates occupancy with a 

brief application of hose streams. As the situation appeared to be coming under control, the wind 

shifted, and the production of smoke and vapors increased dramatically. This made it necessary to 

abandon the establishment decontamination area and all of the equipment that had been assembled 

on the west side of the building. The attack teams were withdrawn quickly at 2058 and directed to 

a clear area.

With the decontamination area unusable, the attack team was gathered in a parking area to await 

decontamination. A considerable delay was encountered, during which time one of the company 
USFA-TR-029/April 1989 5

officers reported feeling ill and extremely fatigued. He was decontaminated with a hose stream 

and transported by ambulance to a hospital where he received treatment in a hyperbaric chamber. 

After decontamination, the remaining 14 members of the attack team and the property owner were 

transported to the hospital for evaluation. All of these individuals were tested and released, showing 

no symptoms of exposure injury.

The command post was rapidly relocated and a reassessment of the situation was made. The county 

sheriff’s representative was asked to begin evacuating the residential and business occupancies to 

the north at 2118. The evacuation took place in two phases, eventually involving 1,500 residents. 

Two additional Hazmat teams were requested, from Santa Barbara and Los Angeles Counties, each 

responding from over 50 miles to the scene.

The fire became very spectacular as the large quantities of flammable liquids stored in the building became involved. Flames extended to the two occupancies north of the chemical company, 

and they were also totally destroyed. With most of the available fuel consumed, the fire died down 

at approximately 0200 hours. Hazmat teams’ members wearing B-level protective clothing over 

structural firefighting protective clothing made an entry into the fire area at that time to complete 

extinguishment.

Runoff from the fire was contained by diking the roads and parking lots around the building. In the 

process of diking, an additional fire department member reported symptoms of exposure to chemical vapors while assisting a backhoe operator. This member was also transported to the hospital and 

was released after evaluation.

The amount of water used by firefighters was held to a minimum, but a broken domestic water pipe 

added considerably to the runoff volume and to the concern with water reactive chemicals in the 

building. Hazardous waste contractors collected all of the liquid and contaminated soil after the site 

was turned over to environmental health authorities. Residents of the town were able to return to 

their homes at dawn, but several adjoining businesses remained inaccessible for several days.

Fire investigators were unable to determine the cause of the fire due to the total destruction of the 

area of origin.

LESSONS LEARNED

This incident provides emphasis for several important points that relate to incidents in Hazmat 

occupancies and, in particular, to firefighter health and safety. In reinforced the three priority considerations for a Hazmat incident:

1. Life Safety

2. Protection of the Environment

3. Protection of Property

Specific lessons learned include the following:

1. A fire department must be active in prevention, planning, and information management to 

be prepared when a serious fire occurs.

In this fire, knowledge of the hazards involved was sufficient to keep firefighters out of the 

building and to reduce the risk of serious injury or exposure. The available information was 

managed well and proved to be extremely valuable. Although persistent efforts to enforce code 
6

requirements were unsuccessful, the fire department established that it tried to take the actions 

within its power to prevent this incident.

2. Access to reserves of specialized skills and equipment may be needed in a Hazmat incident.

The availability of the inspector who had conducted code enforcement activities to respond to 

the incident proved very helpful to the incident commander. On the other hand, more trained 

decontamination personnel were needed, as well as a reserve of decontamination equipment 

and supplies. Assistance had to be requested from distant sources.

3. A finance officer should be assigned at incidents where the need for extensive accounting 

and cost recovery activities can be anticipated.

Several agencies and private sector organizations are currently involved in analyzing the financial 

outcome of this incident.

4. When evacuating an area, even businesses that appear to be closed need to be checked for 

occupants.

At least one occupant was found to have spent the night in an occupancy inside the immediate 

danger area, unaware of the fire. Also, better perimeter control was needed to restrict access to 

the evacuated area and the area where operations were conducted.

5. The incident commander needs to develop a viable contingency plan, in case the primary 

plan proves unsuccessful.

A wind shift and a change in fire conditions made it necessary to abandon the original plan, 

relocate, and regroup. This process caused an excessive delay in decontaminating the entry team 

and could have had more several consequences.

6. Procedures are needed to turn over control of the incident scene to other agencies after the 

fire department has completed its primary activities.

After the incident commander’s function was terminated, there was no single source of information or direction with respect to the incident. A single post-incident point-of-contact is needed 

within the fire department, as well as clear identification of the agency assuming jurisdiction 

over the incident site. Other agencies involved in Hazmat incidents are often not accustomed to 

assuming control of the scene in a structured manner.

7. Hazmat teams need guidance on the proper protective ensembles to wear when faced with 

a combination fire/chemical incident.

During the overhaul stage of this fire, the B-level protection over regular turnout clothing proved 

to be adequate. Normally, entry to this type of hazard would be made with A-level protection, 

but the current ensembles do not interfere with fire protective clothing.

8. Safety officers and supervisors need to remain vigilant throughout every incident.

Extended duration incidents require constant observation by supervisors and safety officers to 

ensure that safety procedures are maintained.
7

Appendix A

Site Diagram

provided by Ventura County Fire Department

Appendix A
8

Appendix B

Photographs

provided by Ventura County Fire Department
USFA-TR-029/April 1989 9
10 U.S. Fire Administration/Technical Report Series
USFA-TR-029/April 1989 11
12 U.S. Fire Administration/Technical Report Series