Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 06/17/2024
    TIME: 0656
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-3442
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
UNFI
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. Ammonia<5 Lbs.VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party: Due to a mechanical failure, ammonia began releasing from a valve pinhole on Evaporator #9 at the incident location. No alarms were set off due to the small amount of ammonia released. Three personnel were on scene at the time of release and one was transported to the hospital for reported dizziness. The reporting party isolated the evaporator and all valves, pumping down the evaporator so that no ammonia remaining in the tank which stopped the release. A contractor was contacted to conduct repairs.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 22150 Golden Crest Dr.
b. CITY:c. COUNTY: d. ZIP:
Moreno Valley
Riverside County92553SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/17/20240245 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 1		NoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.County Environmental Health
d. ADMIN. AGENCY: Riverside County Environmental Healthe. 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, AIR RESOURCES BD, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-3442 *********

Created by: Warning Center on: 06/17/2024 06:56:19 AM Last Modified by: Warning Center on: 06/17/2024 07:09:23 AM