Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 04/15/2011
TIME: 1747
RECEIVED BY: CONTROL#:
Cal OES - 11-2398
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
CST Inc
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Oil - Hydraulic=16 Oz.PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Back-up generator had a blow off which caused release, material flowed onto the concrete and soil, Patriot handled the containment and clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
YesNo
l. KNOWN IMPACTNone
3. a. INCIDENT LOCATION: 25406 State Highway 189 (CST Inc)
b. CITY:c. COUNTY: d. ZIP:
Twin Peaks
San Bernardino County92391SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
04/11/20111500 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: San Bernardino County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
i. RWQCB Unit:
7
AA/CUPA, DFG-OSPR, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
********* Control No: 11-2398 *********

Created by: Warning Center on: 04/15/2011 05:47:45 PM Last Modified by: Warning Center on: 04/15/2011 05:53:29 PM