Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/30/2024
    TIME: 0316
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5523
    NRC - 1412308
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Premium Environmental Service
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. Hydrogen Peroxide - Solution<55 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A fork-lift operator accidentally struck and damaged a 55-gallon container of the listed substance, causing an unknown amount of the chemical to spill onto a parking lot and enter an enclosed rainwater drainage system. Trucking terminal personnel secured the area, and an environmental specialist has been contacted. The terminal remains operational.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesRainwater drainage system - Enclosed/ PrivateNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 14731 Santa Ana Avenue
b. CITY:c. COUNTY: d. ZIP:
Fontana
San Bernardino CountySOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/30/20240224 Merchant/Business Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
National Response Center (NRC)
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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5523 *********

Created by: Warning Center on: 09/30/2024 03:16:11 AM Last Modified by: Warning Center on: 09/30/2024 03:41:05 AM