Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/11/2024
    TIME: 1433
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6350
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Green Clean Pressure Washing
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. Hydraulic oil=1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party, due to a mechanical failure on a Waste Management truck, a spill of hydraulic oil occurred at the listed location. The spill impacted the asphalt on the road only. No waterways were impacted. Green Clean Pressure Washing will be conducting the clean-up.
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: 3945 Bradford Street
b. CITY:c. COUNTY: d. ZIP:
La Verne
Los Angeles County91750SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/11/20241030 Residence Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: La Verne Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
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: 24-6350 *********

Created by: Warning Center on: 11/11/2024 02:33:18 PM Last Modified by: Warning Center on: 11/11/2024 02:49:51 PM