Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 01/24/2022
TIME: 1723
RECEIVED BY: CONTROL#:
Cal OES - 22-0480
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron Stations Inc
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. Fuel - Gasoline Type=1.5 Pt.(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: During unattended customer vehicle fueling a tank was overfilled causing the release, material flowed onto concrete, on site personnel handled the containment and clean up
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 1235 Florin Rd, Chevron Fuel
b. CITY:c. COUNTY: d. ZIP:
Sacramento
Sacramento County95831SACRAMENTO METROPOLITAN AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
01/24/20221440 Service Station Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoOn site personnel
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Sacramento City Fire Departmente. SEC. AGENCY: Sacramento County Environmental Management
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-0480 *********

Created by: Warning Center on: 01/24/2022 05:23:42 PM Last Modified by: Warning Center on: 01/24/2022 05:34:51 PM