Abstract: EMPLOYEE #2, HIRED AS SUMMER HELP, WAS WORKING INSIDE A CLARIFIER TANK WHICH WAS 6 FEET LONG BY 6 FEET WIDE BY 10 FEET DEEP. HE WAS MANUALLY REMOVING SLUDGE BY LOADING IT INTO BUCKETS WITH A SHOVEL. THIS REMOVAL OPERATION HAD BEEN GOING ON FOR THE PREVIOUS TWO DAYS, FIRST BY PUMPING OUT SLUDGE, THEN BY MANUAL SCOOPING. THE LEVEL OF SLUDGE IN THE TANK WAS APPROXIMATELY ONE FOOT FROM THE BOTTOM. BUCKETS OF SLUDGE WERE HOISTED FROM THE TANK BY ROPE, VIA A BLOCK AND TACKLE IN THE CEILING, BY ANOTHER EMPLOYEE ON THE OUTSIDE. AT APPROXIMATELY 11 AM ON 6-7-85, THE OUTSIDE EMPLOYEE HEARD A THUD IN THE TANK. HE CLIMBED THE LADDER TO INVESTIGATE. HE SAW EMPLOYEE #2 STAGGER IN THE TANK AND THEN FALL OVER INTO THE SLUDGE. THE EMPLOYEE THEN ENTERED THE TANK AND ATTEMPTED TO REVIVE EMPLOYEE #2. HE COULD NOT, SO HE EXITED THE TANK AND RAN INTO THE YARD, WHERE HE ENCOUNTERED A FORKLIFT DRIVER. THE FORKLIFT DRIVER TOLD THE EMPLOYEE TO RUN INTO THE PLANT TO GET HELP. THE FORKLIFT DRIVER THEN ENTERED THE TANK TO ATTEMPT A RESCUE. THE EMPLOYEE WHO HAD GONE FOR HELP THEN RETURNED WITH EMPLOYEE #1 AND SEVERAL OTHERS. EMPLOYEE #1, WHO WAS THE FATHER OF EMPLOYEE #2, ENTERED THE TANK IN AN EFFORT TO RESCUE HIS SON. THE FORKLIFT DRIVER EXITED THE TANK A FEW MINUTES LATER, ASSISTED BY A MAINTENANCE MAN RESPONDING TO THE ACCIDENT. AT THIS POINT THE MAINTENANCE SUPERINTENDENT ARRIVED AND TOOK CHARGE. THE SUPERINTENDENT, PLUS ANOTHER MAINTENANCE MAN, TWICE ATTEMPTED TO RESCUE THE EMPLOYEES IN THE TANK, BUT HAD TO GIVE UP BECAUSE OF THE ATMOSPHERIC CONTAMINATION. THE SUPERINTENDENT FORBADE EVERYONE ELSE TO ENTER THE TANK. AN ATTEMPT WAS MADE TO VENTILATE THE TANK WITH FANS AND A HIGH SPEED BLOWER UNTIL THE RESCUE SQUAD ARRIVED. RESCUE SQUAD MEMBERS, WEARING PROTECTIVE SUITS AND SCBA'S, EXTRACTED THE TWO EMPLOYEES. EMPLOYEE #1 WAS PRONOUNCED DEAD ON ARRIVAL AT THE LOCAL HOSPITAL, AFTER REPEATED CPR ATTEMPTS. EMPLOYEE #2 WAS ADMITTED TO THE HOSPITAL AND LATER RELEASED. NEITHER EMPLOYEE WORKING IN THE TANK WAS WEARING A RESPIRATOR, NOR WERE ANY OF THE COMPANY PERSONNEL WHO ATTEMPTED A RESCUE. THE WERE NO PROCEDURES IN EFFECT FOR ENTERING CONFINED SPACES.