Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 04/15/2024
    TIME: 1134
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-2220
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Food For Less Field Center# 302
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. Diesel Fuel =3-4 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, there was a fuel spill from a pump during the process of refueling a vehicle, resulting in the release of approximately 3-4 gallons onto concrete. No waterways were impacted by this release. Local fire department responded to the incident and utilized kitty litter to absorb the spilled fuel. Contractor en route to ensure the proper disposal of the contaminated litter.
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: 12500 Perris Blvd
b. CITY:c. COUNTY: d. ZIP:
Moreno Valley
Riverside County92557SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
04/15/20240900 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:
Fire Dept.
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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-2220 *********

Created by: Warning Center on: 04/15/2024 11:34:50 AM Last Modified by: Warning Center on: 04/15/2024 11:54:11 AM