Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/30/2021
TIME: 0854
RECEIVED BY: CONTROL#:
Cal OES - 21-6793
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Montclair City Fire Department
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. Diesel=40 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Vehicle accident involving a single car into a parked semi resulted in the release of the substance onto the roadway and approximately 10 gallons released into a storm drain. Public works en route to trace storm drain. Release has been stopped and clean up underway.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm DrainNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: East of Brooks Street and Monte Vista Ave
b. CITY:c. COUNTY: d. ZIP:
Montclair
San Bernardino County91763SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/30/20210840 Road Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoCo. HazMat
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept., OtherPublic WorksCounty Hazmat
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, DFW-OSPR, LANDS, PARKS & REC, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-6793 *********

Created by: Warning Center on: 11/30/2021 08:54:31 AM Last Modified by: Warning Center on: 11/30/2021 09:03:39 AM