Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/18/2023
    TIME: 1004
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-5981
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Green Clean Pressure Washer
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. Engine coolant=1/2 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per caller "Waste Management trash truck had a mechanical failure resulting in the spill of its coolant on to the asphalt. No waterways were impacted. It was stopped and contained. The spill has been cleaned up by reporting party."
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: 919 W Foothill Blvd
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
09/15/20231030 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/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-5981 *********

Created by: Warning Center on: 09/18/2023 10:04:00 AM Last Modified by: Warning Center on: 09/18/2023 10:19:54 AM