Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/27/2018
TIME: 0116
RECEIVED BY: CONTROL#:
Cal OES -
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Cura Emergency Services
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. DELETE=DELETE N/AOTHERDELETENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per RP, release occcured when taker was filling up above ground storage tank and cuppler on the hose disconnected. Release entered a storm drain catch basin and did not go any further. Release was cleaned up from the catch basin,
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm Drain Catch Basin
l. KNOWN IMPACT
3. a. INCIDENT LOCATION: Hertz Car Rental - 782 McDonnell Road
b. CITY:c. COUNTY: d. ZIP:
San Francisco
San Francisco CountyBAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/26/20180930 Other
Description for Other : DELETE
Other
Description for Other : See above description
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoDELETE
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: San Francisco County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
RWQCB Unit:
2
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
********* Control No: *********

Created by: Warning Center on: 11/27/2018 01:16:39 AM Last Modified by: Warning Center on: 11/27/2018 01:21:35 AM