Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/25/2021
TIME: 1053
RECEIVED BY: CONTROL#:
Cal OES - 21-5271
NRC - 1317855
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. Gasoline=Unknown UnknownPETROLEUMNoNo
2. Oil=Unknown UnknownPETROLEUMNoNo
3. = NoNo
g. DESCRIPTION: Per NRC: "THE CALLER STATES THE SRP IS CONDUCTING CAR MAINTENANCE IN THE DRIVEWAY, AND THE BY PRODUCTS ARE RELEASING INTO THE STORM DRAIN."
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedYesStorm DrainUnknown
l. MARITIME VESSEL
No
m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 28915 VIA MASALA
b. CITY:c. COUNTY: d. ZIP:
Menifee
Riverside County92584SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/25/20211100 Residence Other
Description for Other : Dumping
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
NRC
d. ADMIN. AGENCY: Riverside County Environmental Healthe. 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, DFW-OSPR, CDPH-D.O., LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-5271 *********

Created by: Warning Center on: 09/25/2021 10:53:17 AM Last Modified by: Warning Center on: 09/25/2021 10:59:47 AM