Abstract: On November 1, 1995, Employee #1, of a construction company that was installing a new sewer line adjacent to an existing sewer line, entered a manhole to retrieve a sandbag from the existing sewer line. He had checked the confined space using a direct reading multi-gas monitor for oxygen, hydrogen sulfide, carbon monoxide, and combustibles. He entered the manhole without respiratory protective equipment or standby rescue equipment. Employee #1 reportedly saw a white, bubbly liquid that smelled like Raid flow in. His eyes and throat started to burn. He barely managed to climb the ladder to exit the manhole. As he neared the top, a standby coworker helped him exit. Employee #1 was subsequently hospitalized for several days for blurred vision, muscle aches, vomiting, and nausea. Organophosphate pesticide exposure was suspected, but could not be confirmed.