Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/29/2024
    TIME: 0835
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-7220
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron Retail Station
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. Gasoline=3 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the Reporting Party: The material released from a fueling hose after removal from customer vehicle gas tank due to an unknown mechanical issue that occurred with the nozzle. The material impacted the concrete around the fuel pump and approximately 1 to 2 gallons entered a nearby storm drain but was collected in a catch basin to prevent further release. Station personnel cleaned up utilizing spill kit and absorbents. A contractor has also been contacted to completed clean up. There were no injuries associated with the release.
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: 12659 Foothill Blvd
b. CITY:c. COUNTY: d. ZIP:
Rancho Cucamonga
San Bernardino County91701SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/28/20241745 Service Station 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: San Bernardino County Fire Departmente. 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: 24-7220 *********

Created by: Warning Center on: 12/29/2024 08:35:56 AM Last Modified by: Warning Center on: 12/29/2024 08:46:16 AM