Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/28/2022
TIME: 1330		RECEIVED BY: CONTROL#:
Cal OES - 22-6979
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
7-11 Compliance
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. Gasoline <5 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A car collided with a dispenser, causing gasoline to release on to the concrete pad and inside the Under Dispenser Containment (UPC). The cleanup was completed by station personnel and the local fire department, who had responded for the collision. No waterways impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 111 W Valley Blvd
b. CITY:c. COUNTY: d. ZIP:
Rialto
San Bernardino County92376SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/27/20220001 Service Station Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoStation Personnel and Fire Dept.
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
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/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-6979 *********

Created by: Warning Center on: 11/28/2022 01:30:34 PM Last Modified by: Warning Center on: 11/28/2022 01:47:51 PM