HEALTH CONSULTATION

W.R. GRACE AND COMPANY SANTA ANA PLANT
(a/k/a GRACE CONSTRUCTION PRODUCTS)
SANTA ANA, ORANGE COUNTY, CALIFORNIA

APPENDIX A: FIGURES

Figure 1. Intro Map

Figure 2. Age of Structures around Santa Ana Plant, 2000 Census

Figure 3. Age of Structures around Santa Ana Plant, 1990 U.S. Census

Figure 4. Year Householder Moved into Unit, 2000 Census Data

Figure 5. Year Householder Moved into Unit, 1990 U.S. Census Data

Figure 6. Asbestos Levels in Personal Samples Collected by W.R. Grace at the Santa Ana Plant

Figure 7. Asbestos Levels in Indoor Samples inside Santa Ana Plant Collected by W.R. Grace

Figure 8. Wind Rose

APPENDIX B: EPA SAMPLING RESULTS – W.R. GRACE & COMPANY SANTA ANA PLANT⁽²⁾

Table 1. Results of Surface Soil Sample Analysis ^(†)

Sample Type	Sample Location	Asbestos Concentration (% by Volume)	Type of Asbestos
Grab	SW corner of office building in planter	Trace	Tremolite-actinolite
Grab	SE corner of office building in the planter	Trace	Tremolite-actinolite
Composite	Grass area central north portion of site	Non-detect	NA
Composite	Grass area central north portion of site	Non-detect	NA
Composite	Grass area central north portion of site	Non-detect	NA
Composite	Grass area central north portion of site	Non-detect	NA
Composite	Along rail spur north end of site	Non-detect	NA
Composite	Along rail spur parallel with production building	Trace	Tremolite-actinolite, Chrysotile
Composite	Along rail spur south of production building	Trace	Tremolite-actinolite
Grab	At previous conveyor location	Trace	Tremolite-actinolite
Grab	Duplicate of grab sample taken at previous conveyor location	Trace	Tremolite-actinolite
Grab	West of rail spur at south end of the site	Trace	Tremolite-actinolite

† All soil samples were analyzed by Polarized Light Microscopy (PLM)

Table 2. Results of Microvacuum Surface Dust Sample Analysis ^(*)

Sample Type	Sample Location	Number of Asbestos Structures Detected (on the filter sample)	Total Asbestos Concentration (s/cm2) (estimated for the surface area sampled)
Composite	Three separate window sills in the office near the production building.	Non-detect	<32
Composite	Top of control panel and tops of two transformers in production machine area in production building.	Non-detect	<638
Composite	Flammable storage cabinet, transformer and storage cabinet in production building warehouse area	1 structure (0.5 to 5 m)	2,552
Blank Sample	Blank Sample	Non-detect	NA
Blank Sample	Blank Sample	Non-detect	NA

* All microvacuum dust samples were analyzed by ISO Method 10312 (TEM). Results reported as "Number of Asbestos Structures Detected" correspond to the actual number of structures observed during analysis of a portion of the microvacuum filter. The "Total Asbestos Concentration" values are estimated for the surface area sampled.

Table 3. Results of Indoor Air Sample Analysis ^(*)

Sample Type	Sample Location	Asbestos Result	Type of Asbestos
Air	Production building Office copy room	Non-detect(†)	NA
Air	Production building Central warehouse area	Non-detect	NA
Air	Production building North warehouse area	Non-detect	NA
Air	Production area of production building	Non-detect	NA
Blank	Blank sample	Non-detect	NA
Blank	Blank sample	Non-detect	NA

* All air samples were analyzed by ISO Method 10312 (TEM).
† Analytical sensitivity for all ambient air samples is 0.0009 s/cc.

APPENDIX C: HEALTH HAZARD CATEGORY DEFINITIONS

Public health hazard categories are statements about whether people could be harmed by conditions present at the site in the past, present, or future. One or more hazard categories might be appropriate for each site. The five public health hazard categories are no public health hazard, no apparent public health hazard, indeterminate public health hazard, public health hazard, and urgent public health hazard.

No public health hazard
A category used in ATSDR's public health assessment documents for sites where people have never and will never come into contact with harmful amounts of site-related substances.

No apparent public health hazard
A category used in ATSDR's public health assessments for sites where human exposure to contaminated media might be occurring, might have occurred in the past, or might occur in the future, but where the exposure is not expected to cause any harmful health effects.

Indeterminate public health hazard
The category used in ATSDR's public health assessment documents when a professional judgment about the level of health hazard cannot be made because information critical to such a decision is lacking.

Public health hazard
A category used in ATSDR's public health assessments for sites that pose a public health hazard because of long-term exposures (greater than 1 year) to sufficiently high levels of hazardous substances or radionuclides that could result in harmful health effects.

Urgent public health hazard
A category used in ATSDR's public health assessments for sites where short-term exposures (less than 1 year) to hazardous substances or conditions could result in harmful health effects that require rapid intervention.

APPENDIX D: TABLE 1 - EXPOSURE PATHWAYS- VERMICULITE PROCESSING FACILITIES

SOURCE FOR ALL PATHWAYS: Libby Asbestos-contaminated Vermiculite from Libby, Montana

PATHWAY NAME	ENVIRONMENTAL MEDIA & TRANSPORT MECHANISMS	POINT OF EXPOSURE	ROUTE OF EXPOSURE	EXPOSURE POPULATION	TIME
Occupational	Suspension of Libby asbestos fibers or contaminated dust into air during materials transport and handling operations or during processing operations	Onsite	Inhalation	Former workers	Past
	Suspension of Libby asbestos fibers into air from residual contamination inside former processing buildings	Inside former processing buildings	Inhalation	Current workers	Present, Future
Household Contact	Suspension of Libby asbestos fibers into air from dirty clothing of workers after work	Workers' homes	Inhalation	Former and/or current workers' families and other household contacts	Past
Waste Piles	Suspension of Libby asbestos fibers into air by playing in or otherwise disturbing piles of vermiculite or waste rock	Onsite, at waste piles	Inhalation	Community members, particularly children	Past
Onsite Soils	Suspension of Libby asbestos fibers into air from disturbing contaminated material remaining in onsite soils (residual soil contamination, buried waste)	At areas of remaining contamination at or around the site	Inhalation	Current onsite workers, contractors, community members	Present, future
Ambient Air	Stack emissions and fugitive dust from plant operations into neighborhood air	Neighborhood around site	Inhalation	Community members, nearby workers	Past
Residential Outdoor	Suspension of Libby asbestos fibers into air by disturbing contaminated vermiculite brought offsite for personal uses (gardening, paving driveways, traction, fill)	Residential yards or driveways	Inhalation	Community members	Past, present, future
Residential Indoor	Suspension of household dust containing Libby asbestos from plant emissions or waste rock brought home for personal use	Residences	Inhalation	Community members	Past, present, future
Consumer Products	Suspension of Libby asbestos fibers into air from using or disturbing insulation or other consumer products containing Libby vermiculite.	At homes where Libby asbestos-contaminated products were/are present	Inhalation	Community members, contractors, and repairmen	Past, present, future

APPENDIX E: HEALTH STATISTICS REVIEW FOR POPULATIONS IN CLOSE PROXIMITY TO THE W.R. GRACE AND COMPANY FACILITY IN SANTA ANA, CA

Background

Through an analysis of mortality records, ATSDR and the Montana Department of Public Health and Human Services detected a statistically significant excess of asbestos-related disease (asbestosis) among residents of Libby, MT (1). Rates of asbestosis were 60 times higher than the national rates and this difference was highly unlikely due to natural fluctuations in the occurrence of this disease. This discovery led to several follow-up activities in Libby to address the health impacts on the community (2, 3). Another follow-up activity was a nation-wide effort to screen for a similar impact on the health of communities near facilities that processed or received vermiculite ore from the mine in Libby. As part of that activity, ATSDR awarded the California Department of Health Services (CDHS) funding to conduct health statistics reviews (HSR) on sites within CA that may have received the asbestos-contaminated Libby ore. HSRs are statistical analyses of existing health outcome data (e.g., cancer registry data and/or death certificate data) that help provide information on whether people living in a particular community have gotten asbestos-related diseases more often than a comparison population (i.e., people living in the rest of the country). Finding an excess of asbestos-related disease in a community through an HSR analysis would inform ATSDR and CDHS to the possibility that workers and/or community members might have been exposed to Libby asbestos from the vermiculite ore. Therefore, ATSDR has funded CDHS and other state health departments to conduct HSRs for all of the communities near vermiculite facilities, regardless of whether it is known if the community was exposed to Libby asbestos through the processing or handling of vermiculite ore. The methodology of the HSR used for Santa Ana and other vermiculite sites across the US was developed by ATSDR (4).

Methods

Cancer registry records were chosen by CDHS and ATSDR for this HSR because these are detailed health outcome records which are readily accessible in the state of California. ATSDR and CDHS are currently exploring the feasibility of conducting HSRs for this and other sites around the state using death certificate data. The target area consisted of people who were diagnosed with potential asbestos-related cancers while residing within any of the five census tracts surrounding the WR Grace Santa Ana site (740.03, 740.04, 740.05, 741.03 and 742.00). These census tracts were chosen as the geographic boundary for analysis because it is the smallest geographic area that is electronically coded on CA cancer registry records. The analysis period used was from 1986 to 1995. This period was used by CDHS because 1) it covers the most recent 10 years worth of cancer incidence data available in most firmly established cancer registries, 2) it corresponds to an approximate latency period in which initial exposure occurred and onset of disease would be expected, and 3) it allows for enough years worth of data for meaningful analyses. There were eight disease groupings used for this cancer incidence analysis; these can be found in ATSDR's HSR protocol (4). Of the eight groupings, the three of greatest interest to ATSDR were the cancers that have a known association with asbestos exposure. These three include malignant neoplasm of mesothelium [ICD-0-2 M-9050:9053], malignant neoplasm of peritoneum, retroperitoneum, and pleura [ICD-0-2 C480:C488, C384, excluding type M-9590:9989], and malignant neoplasm of lung and bronchus [ICD-0-2 C340:C349, excluding type M-9590:9989]. The other five disease groupings analyzed were reported in the literature as having weaker associations with asbestos exposure or were ones that were included to evaluate reporting/coding anomalies in the target area.

Gender specific age-standardized incidence ratios (SIRs) were calculated for asbestos-related cancers. An SIR is a measure of whether the number of people who got cancer in this Santa Ana community is the same as, lower, or higher than the number of people we would expect to find if the occurrence of cancer in the Santa Ana community was the same as the occurrence of cancer in a comparison population. The comparison population used in this analysis was for the rest of the country. This comparison population was national cancer registry data received from the Surveillance, Epidemiology, and End Results (SEER) program at the National Cancer Institute (5). If the number of people getting cancer in this Santa Ana community is the same as the number we would expect to find, the SIR will equal 1. If the number of Santa Ana community members getting cancer is less than one would expect, the SIR will be between 0 and 1. If the number of Santa Ana members getting cancer is more than one would expect, the SIR will be greater than 1.

The number of people who get cancer in the United States changes from year to year (this is part of the nature of cancer as a disease). As a result, the value of the SIR for a community will also change, depending on which years are being studied: one year, the SIR may be higher than 1 (e.g., 1.2), and the next year it may be less than 1 (e.g., 0.9). Some degree of fluctuation in the SIR values from year to year is considered normal.

An important question is: when is a SIR higher or lower than what would be expected? In other words, when are more or fewer people getting cancer than we would expect, taking into account that there is a normal fluctuation in the number of people getting cancer? In order to answer this question, a measure called a 95% confidence interval (CI) is calculated for the SIR using Byar's approximation (6). The 95% CI consists of two numbers which define a range (a lower and an upper) of expected, or normal, values for the SIR for a community. If both numbers are less than 1, then we conclude that cancer is occurring less frequently in the community than it is in the rest of the country (this is called a statistically significant decrease). If both of the numbers in the confidence interval are higher than 1, then we conclude that cancer is occurring more frequently in the community than it is in the rest of the country (this is called a statistically significant excess). Lastly, if one of the numbers in confidence interval is less than 1 and the second number is higher than 1, then we conclude that cancer is occurring in the community at the same frequency as it is occurring in the rest of the country (this is called a non-statistically significant difference).

Results

Table A shows, for each cancer group studied: 1) whether past studies have shown a link between asbestos exposure and that type of cancer; 2) the number of people in the Santa Ana community who got each type of cancer; 3) the number of people we would expect to get cancer if the community had the same occurrence of cancer as the rest of the country; 4) the SIR; and 5) the 95% confidence interval for the SIR.

For the time period 1986-1995, the occurrence of these eight types of cancer in the Santa Ana community was the same as the occurrence in the rest of the country.

The results for the types of cancers that are known to result from asbestos exposure are:

• The numbers of people who developed mesothelioma and neoplasm of the peritoneum, retroperitoneum, and pleura were slightly higher than expected (the SIR is greater than 1). However, these numbers are within the normal range of what we would expect if the occurrence of cancer in this community was the same as the occurrence of cancer in the rest of the country (the lower number of the confidence interval is less than one and the upper number is greater than one).



• The number of people who developed lung or bronchus cancer was less than expected (the SIR is less than 1), however this number is within the normal, or expected, range.

Therefore, cancers caused by exposure to asbestos are not occurring more frequently in the Santa Ana community than they are in the rest of the country.

The number of people in this Santa Ana community who got cancers with weak associations with asbestos exposure is less than expected (the SIR is less than 1). However, this difference is within the normal, or expected, range. There is no difference between the occurrence of these cancers in the Santa Ana community and their occurrence in the rest of the country.

Lastly, the occurrence of cancers with no known link to asbestos exposure was either significantly less frequent than the rest of the country, or the same as the rest of the country.

Discussion and Limitations:

The main goal of conducting these HSRs is to help determine if communities near facilities that received Libby vermiculite have higher than expected occurrences of asbestos-related cancers and disease. This SIR analysis suggests that the occurrence of asbestos-related cancers in this Santa Ana population is not higher than expected compared to the rest of the country.

There are many limitations to using existing data sources to examine the relationship between environmental exposures and chronic diseases such as cancer. (A chronic disease is one that develops over a long period of time.) Some of the major limitations in this analysis include, but are not limited to: exposure misclassification, population migration, lack of control for confounding factors (i.e., smoking status data), overstated numerators/under-estimated denominators, large study areas, small numbers of cases, and under-reporting of cancer cases to the state registry (4). Most of these limitations would make it less likely (as opposed to more likely) that this type of analysis would identify an abnormally high occurrence of asbestos-related cancers among people who lived near the WR Grace & Co. facility during its years of operation.

References

1. Dearwent S. Mortality in Libby, Montana, 1979 - 1998. Agency for Toxic Substances and Disease Registry, December 2000.



2. Lybarger J, Lewin M, Miller A, Kess S. Preliminary Findings of Medical Testing of Individuals Potentially Exposed To Asbestoform Minerals Associated with Vermiculite in Libby, Montana: An Interim Report for Community Health Planning. Agency for Toxic Substances and Disease Registry, February 2001.



3. Lybarger J, Lewin M, Miller A, Kess S. Report to the Community: Medical Testing of Individuals Potentially Exposed To Asbestoform Minerals Associated with Vermiculite in Libby, Montana from July through November, 2000. Agency for Toxic Substances and Disease Registry, August 2001.



4. Horton DK, Kaye WE. Health Statistics Review Protocol for U.S. Communities that Received Asbestos-Contaminated Vermiculite from Libby, Montana. Agency for Toxic Substances and Disease Registry, April 2001.



5. Surveillance, Epidemiology, and End Results. SEER Cancer Incidence Public-Use Database, 1973-1997, SEER*Stat 3.0, April 2000. National Cancer Institute (NCI).



6. Breslow NE and Day NE: Statistical Methods in Cancer Research, Vol. 2 - The design and analysis of cohort studies. Oxford U Press, NY: International Agency for Research on Cancer, 1989.

Table A: Cancer registry data findings for selected cancer cases diagnosed in close proximity to the W.R. Grace and Company facility in Santa Ana, CA (Census Tracts 740.03, 740.04, 740.05, 741.03 and 742.00)

Cancer Group (ICD-0-2 codes)	Past studies have shown a link to asbestos exposure?	Number of people who got cancer	Expected number of cases*	SIR†	95% confidence interval‡
					Lower	Upper
Malignant neoplasm of lung and bronchus (C340:C349, excluding M-9590:9989)§	Yes	79	95.41	0.83	0.66	1.03
Malignant neoplasm of peritoneum, retroperitoneum, and pleura (C480:C488, C384, excluding M-9590:9989)§	Yes	6	2.68	2.24	0.82	4.87
Malignant neoplasm of mesothelioma (M-9050:9053)§	Yes	4	1.49	2.68	0.72	6.87
Malignant neoplasm of digestive organs (C150:C218, C260:C269, excluding M-9590:9989)	Weak link	79	103.95	0.76	0.60	0.95
Malignant neoplasm of respiratory system and intrathoracic organs (C320:C399, excluding M-9590:9989)	Weak link	86	104.98	0.82	0.66	1.01
All malignant neoplasms (C000:C809)	No	595	728.70	0.82	0.75	0.88
Malignant neoplasm of female breast (C500:C509, excluding M-9590:9989)	No	101	110.23	0.92	0.75	1.11
Malignant neoplasm of prostate (C619, excluding M-9590:9989)	No	77	88.01	0.87	0.69	1.09

* Calculated using national cancer registry data received from the Surveillance, Epidemiology, and End Results (SEER) (5).

† The Standardized Incidence Ratio (SIR) equals the number of people who got the disease divided by the expected number of cases.

‡ The 95% CIs were calculated to assess statistical significance using Byar's approximation (6).

§ Have known associations with asbestos exposure. The other disease groupings analyzed were reported in the literature as having weaker associations with asbestos exposure or were ones that were included to evaluate reporting/coding anomalies in the target area.

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2 US Environmental Protection Agency. Focused removal assessment report for W.R. Grace & Co. Santa Ana: CDM for US Environmental Protection Agency. 2001.

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