Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/19/2024
    TIME: 1117
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5301
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Manager for School District
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. Formula 50=20-30 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party. The release was caused by a fork-lift driver puncturing a 55 gallon barrel drum that was about half full. The release was approximately 20-30 gallons of Formula 50 that impacted the concrete but did not go into a waterway. The release was stopped and contained in a transportation area. The release was cleaned up by the reporting party and a contractors.

Per reporting party,
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 404 West 4th St
b. CITY:c. COUNTY: d. ZIP:
Ontario
San Bernardino County91762SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/10/20240745 Other
Description for Other : Transportation Dept		Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CUPA
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, CDPH-D.O., Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5301 *********

Created by: Warning Center on: 09/19/2024 11:17:01 AM Last Modified by: Warning Center on: 09/19/2024 11:40:51 AM