Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 06/09/2023
    TIME: 2020
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-3791
    NRC - 1369649
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
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. Diesel=Unknown UnknownPETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC: "CALLER IS REPORTING A SPILL OF DIESEL ONTO THE GROUND FROM FUEL PUMPS AT THE INCIDENT LOCATION DUE TO FAULTY EQUIPMENT. CALLER STATED THE SPILLS OCCUR DAILY. CALLER STATED THE GROUND IS DARK WHERE THE SPILL OCCUR."
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 25128 BROADWELL AVENUE
b. CITY:c. COUNTY: d. ZIP:
Harbor City
Los Angeles County90710SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/09/20231600 Service Station Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Los Angeles City 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/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-3791 *********

Created by: Warning Center on: 06/09/2023 08:20:05 PM Last Modified by: Warning Center on: 06/09/2023 08:31:40 PM