Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 08/04/2022
TIME: 1652
RECEIVED BY: CONTROL#:
Cal OES - 22-4469
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Grocery Outlet
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. R44HA=200 Lbs.VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: The pipe on a refigerator broke releasing R44HA into the air. Upon the arrival of the FD, the store was evacuated. A private contractor arrived on scene and secure the release. The pipe was repaired and evacuation has been lifted.
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: 57200 29 Palm Highway Suite 101
b. CITY:c. COUNTY: d. ZIP:
Yucca Valley
San Bernardino County92284MOJAVE DESERT AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/04/20221400 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept.
d. ADMIN. AGENCY: San Bernardino County Fire Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

7
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: 22-4469 *********

Created by: Warning Center on: 08/04/2022 04:52:34 PM Last Modified by: Warning Center on: 08/04/2022 04:59:35 PM