Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 07/13/2024
    TIME: 1220
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4005
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Broadbent & Associates
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. Gas=2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party: A customer experienced an overflow of gas from their gas tank while refueling their vehicle. It is unknown if the individual left the pump while refueling or attempted to top off the gas tank that caused the release. The material landed on the concrete and moved into a nearby storm drain / catch basin where it remained. The gas did not make it to the lateral and thus did not enter the nearby retention pond. On scene service station personnel applied absorbents and Ancon Environmental Services was contacted to finish clean up and collection of the material.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm Drain / Catch BasinNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 15100 N. Thornton Road
b. CITY:c. COUNTY: d. ZIP:
Lodi
San Joaquin County95242SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/13/20240200 Service Station Human Error
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 Joaquin County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4005 *********

Created by: Warning Center on: 07/13/2024 12:20:55 PM Last Modified by: Warning Center on: 07/13/2024 12:32:37 PM