Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 01/17/2019
TIME: 2012
RECEIVED BY: CONTROL#:
Cal OES - 19-0432
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron
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=1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states that 1 gallon of diesel was released onto the concrete pump station due to customer error, the release has been stopped and contained, station personnel conducted cleanup.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. KNOWN IMPACTNone
3. a. INCIDENT LOCATION: 9484 West Lane
b. CITY:c. COUNTY: d. ZIP:
Stockton
San Joaquin County95210SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
01/17/20191500 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 Joaquin County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
RWQCB Unit:
5B
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
********* Control No: 19-0432 *********

Created by: Warning Center on: 01/17/2019 08:12:53 PM Last Modified by: Warning Center on: 01/17/2019 08:18:51 PM