Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/07/2024
    TIME: 0956
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6278
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Riverside County Environmental Health HazMat
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=2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party: Due to a vehicle collision into a terminal at a gas station, gasoline released onto concrete. Cleanup is complete.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 7/11, 4488 N Perris Blvd
b. CITY:c. COUNTY: d. ZIP:
Perris
Riverside County92571SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/07/20241141 Service Station Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoStore Employee
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CALFIRE, Co Health, Sheriff Ofc.
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, CALFIRE, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6278 *********

Created by: Warning Center on: 11/07/2024 09:56:49 AM Last Modified by: Warning Center on: 11/07/2024 10:05:02 AM