Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 05/26/2022
TIME: 0948		RECEIVED BY: CONTROL#:
Cal OES -
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
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. sadf=d22 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: adfasdfafd
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION:
b. CITY:c. COUNTY: d. ZIP:
Vernon
Los Angeles CountySOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/26/20220900 Treatment/Sewage Facility
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Vernon Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: Contra Costa County g. ADMIN. AGENCY: Contra Costa County Health Services Department
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region: Coastal
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, EDO, FDC, Cal OES REG, LDO
Photo Attachment:
11. Cal OES Reg. sarah.finnigan@caloes.ca.gov
********* Control No: *********

Created by: Warning Center on: 05/26/2022 09:48:21 AM Last Modified by: Warning Center on: 06/23/2022 04:37:30 PM