Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 05/23/2022
    TIME: 1247
    RECEIVED BY:
    CONTROL#:
    Cal OES - 22-2937
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Environmental Restoration on behalf of Fed Ex Freight
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. Non-Regulated Roofing Material=40 Gal(s)OTHERNon-Regulated Roofing MaterialNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Reporting Party states a pallet shifted from the truck while off loading. The impact from the fall caused the drum to leak. The leak has been stopped, the spill is contained. The spill was contained to the asphalt, no drains or waterways were impacted. A contractor will provide clean-up for the spill.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 9600 Kiser Way
b. CITY:c. COUNTY: d. ZIP:
Fontana
San Bernardino County92335SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/23/20221207 Road Unknown
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 Fire Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

8
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-2937 *********

Created by: Warning Center on: 05/23/2022 12:47:31 PM Last Modified by: Warning Center on: 05/23/2022 12:58:08 PM