Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 01/24/2023
    TIME: 1923
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-0726
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Broadbent and Associates
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=10-15 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Saddle bag on a semi truck was punctured due to unknown reasons resulting in the release of the listed substance onto the asphalt and concrete only. No waterways impacted. Sand, absorbents and pads used to mitigate the release. Contractor checked local catch basins and roadway, confirmed no release aside from the service station.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 345 Roth Road (Flying J Station)
b. CITY:c. COUNTY: d. ZIP:
Lathrop
San Joaquin County95330SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
01/24/20231350 Service Station Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
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:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-0726 *********

Created by: Warning Center on: 01/24/2023 07:23:59 PM Last Modified by: Warning Center on: 01/24/2023 07:29:53 PM