Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/12/2023
    TIME: 1935
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-5866
    NRC - 1378920
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
National Response Center (NRC)
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Gas=3 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: per NRC: CALLER REPORTED A CUSTOMER WAS FILLING THEIR VEHICLE AND FORGOT TO TAKE THE NOZZLE OUT OF THE TANK RESULTING IN A SPILL OF THREE GALLONS OF GASOLINE ONTO THE GROUND AND A COLLECTION DRAIN.

Environmental Impact: UNKNOWN
Media Interest: UNKNOWN
ABSORBENTS APPLIED, CONTRACTOR HAS BEEN HIRED
Release Secured: YES

Environmental Impact: UNKNOWN
Media Interest: UNKNOWN
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 24625 Madison Ave
b. CITY:c. COUNTY: d. ZIP:
Murrieta
Riverside CountySOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/12/20231200 Service Station Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Riverside County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

9
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-5866 *********

Created by: Warning Center on: 09/12/2023 07:35:27 PM Last Modified by: Warning Center on: 09/12/2023 07:50:59 PM