Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/27/2023
    TIME: 1618
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-6191
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Broadbent
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Pilot Flying J
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Gasoline<2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP stated, Due to human error an overflow led to a release of approximately one to two (1-2) gallons of gasoline only onto asphalt and concrete. The release was stopped, contained with absorbent, no waterways impacted, no drinking water impacted, and cleaned up. The NRC will not contacted and OES will be contacted in regards to updates for this release.

h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 345 Roth Rd.
b. CITY:c. COUNTY: d. ZIP:
Lathrop
San Joaquin CountySAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/27/20231400 Service Station Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
San Joaquin County Health Department
d. ADMIN. AGENCY: San Joaquin County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/WP, Co/Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-6191 *********

Created by: Warning Center on: 09/27/2023 04:18:31 PM Last Modified by: Warning Center on: 09/27/2023 04:28:53 PM