Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/12/2024
    TIME: 1151
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6366
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Anonymous
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. Formaldehyde=2 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party: There is an ongoing issue at the hospital with the disposing of Formaldehyde. Every other day, the Pathology staff dispose of the chemical in the sink without verifying with the policy the correct form of disposal. The director is aware of the issue, it was brought to his attention in January 2024 but nothing has been done about it.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stoppedYesSink No
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 178 North Garey Ave
b. CITY:c. COUNTY: d. ZIP:
Pomona
Los Angeles County91767SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
01/15/20241000 Other
Description for Other : Hospital 		Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Pomona Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6366 *********

Created by: Warning Center on: 11/12/2024 11:51:18 AM Last Modified by: Warning Center on: 11/12/2024 12:11:36 PM