Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/28/2023
    TIME: 1558
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-7331
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Solvone
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. Unleaded Gasoline =2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Reporting Party : A customer drove away from a gas pump at a fueling station with the gas pump nozzle still in their vehicle causing the release of approximately 2 gallons of gasoline. Spilled gasoline impacted concrete surrounding fuel pump #2; it did not leave the pad. Clean up was conducted using cleaning solution. No waterways impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 6404 Mission Gorge Road - Jackson Energy Gas Station #6837
b. CITY:c. COUNTY: d. ZIP:
San Diego
San Diego County92120 SAN DIEGO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/28/202315:20 Service Station Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: San Diego County Health Services Departmente. 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/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-7331 *********

Created by: Warning Center on: 11/28/2023 03:58:18 PM Last Modified by: Warning Center on: 11/28/2023 04:07:12 PM