Governor's Office Emergency Services |
TIME: 1420 |
|
Cal OES - 23-7418 NRC - 1385693 |
1. NAME: | 2. AGENCY: | 3. PHONE#: | 4. Ext: | 5. PAG/CELL: |
![]() | NRC | ![]() | ![]() | ![]() |
1. NAME: | 2. AGENCY: | 3. PHONE#: | 4. Ext: | 5. PAG/CELL: |
![]() | Private Citizen | ![]() | ![]() | ![]() |
2. a. SUBSTANCE: | b.QTY:>=< | Amount | Measure | c. TYPE: | d. OTHER: | e. PIPELINE | f. VESSEL >= 300 Tons |
1. Gasoline | = | Unknown | Unknown | PETROLEUM | No | No | |
2. | = | No | No | ||||
3. | = | No | No |
g. DESCRIPTION: | Per the NRC Report : "Caller reported a discharge of an unknown amount of gasoline from a passenger car. Caller stated that the unknown individual fueling the car left the pump unattended and the tank of the car overfilled." Remedial Actions : "Another unknown individual removed the nozzle from the vehicle." | ||
![]() | ![]() | ![]() | ![]() |
h. STOPPAGE/CONTAINMENT: | i. WATER INVOLVED: | j. WATERWAY: | k. DRINKING WATER IMPACTED |
Unknown if stopped, Unknown if contained | No | N/A | No |
![]() | ![]() | ![]() | |
l. MARITIME VESSEL No | ![]() | m. KNOWN IMPACT Unknown | ![]() |
![]() | ![]() | ![]() | ![]() |
3. a. INCIDENT LOCATION: 2560 Sycamore Dr | |||
b. CITY: | c. COUNTY: | d. ZIP: | ![]() |
![]() | ![]() | ![]() | ![]() |
Simi Valley | Ventura County | 93065 | VENTURA COUNTY APCD |
4. INCIDENT DESCRIPTION: | |||
a. DATE: | b. TIME (Military): | c. SITE: | d. REPORTED CAUSE |
12/02/2023 | 14:05 | Service Station | Human Error |
![]() | ![]() | ![]() | |
![]() | ![]() | ![]() | ![]() |
e. INJURIES | f. FATALITY | g. EVACUATION | h. CLEANUP BY: |
No | No | No | Unknown |
6. NOTIFICATION INFORMATION: | ||
a. ON SCENE: | b. OTHER ON SCENE: | c. OTHER NOTIFIED: |
d. ADMIN. AGENCY: Ventura County Environmental Health | ![]() | e. SEC. AGENCY: |
f. ADDITIONAL COUNTY: | ![]() | g. ADMIN. AGENCY: |
h. NOTIFICATION LIST: | ![]() | ![]() |
Cal GEM: | RWQCB Unit: | 4 |
Cal OES Region: | ![]() | |
![]() | ||
![]() | ![]() | ![]() |
Photo Attachment: | ![]() |