Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 06/17/2024
    TIME: 1735
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-3463
    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. Gasoline =20 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the Reporting Party : A customer over filled the gas tank on their vehicle causing the release. The gas nozzle was left unattended and did not automatically shut off. The gasoline impacted the concrete pavement around the gas pump. No storm drains or waterways were impacted. The release has been stopped. Facility personnel on site deployed granular absorbents to contain it; a contractor crew is currently on site completing removal.
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: 304 North Vermont Street - United Pacific Gas Station
b. CITY:c. COUNTY: d. ZIP:
Los Angeles
Los Angeles CountyUnknown SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/17/20241430 Service Station Human Error
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: 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/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-3463 *********

Created by: Warning Center on: 06/17/2024 05:35:06 PM Last Modified by: Warning Center on: 06/17/2024 05:42:46 PM