At approximately 3:15 pm on May 9, 1986, employees started to charge the number 1 line Carbo-Cooler, using a cylinder containing 150 pounds of anhydrous ammonia at 129 psi (room temperature). Employee #1, in an effort to speed the charging process, was running hot water (132 degrees F) over the ammonia cylinder (to raise the internal pressure). Approximately 15 minutes later the cylinder fails, releasing NH3 into the workplace. Nine (9) days later, Employee #1 died in a burn unit.