On August 6, 2012, the Chevron Richmond Refinery experienced a catastrophic pipe failure in the #4 crude unit. A 52-inch long carbon steel piping component of the #4 side cut line ruptured and released flammable hydrocarbon process fluid, resulting in a large vapor cloud that engulfed 19 Chevron employees and ignited. All of the employees escaped, narrowly avoiding serious injury. 

The ignition of the flammable portion of the vapor cloud and subsequent continued burning of the hydrocarbon process fluid resulted in a large plume of particulates and vapor traveling across the Richmond, California area.

Approximately 15,000 people from the surrounding area sought medical treatment due to the release.

Management System Failures – Corrective Actions Not Implemented/Ineffectively Implemented

• Chevron failed to apply learnings from a 2007 sulfidation corrosion failure at Richmond throughout the crude unit. The failed carbon steel spool from 2007 was replaced with a spool of upgraded metallurgy; however, the more corrosion resistant metallurgy was not implemented more broadly in the crude unit.
• Chevron failed to implement recommendations from internal technical staff in 2009 regarding upgrading carbon steel piping on the crude unit to 9-Chrome prior to the incident. 
• Inspection of several spools of the #4 sidecut during 2011 resulted in several thinned spool sections being identified and replaced; however, further inspection of the remaining sections of line was not conducted.
• A PHA for the crude unit conducted in 2009 did not identify corrosion as a potential cause of a piping rupture; the PHA cited non-specific, qualitative safeguards to reduce risk. 
• The effectiveness of these safeguards was neither evaluated, documented nor verified; instead the safeguards were merely listed in the PHA.