Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/16/2023
    TIME: 1104
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-5957
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
San Rafael Fire Department
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 =15 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Caller states due to reasons unknown, vehicle went off the roadway causing the release of approx 15 gallons of gasoline into the canal. The release is stopped but not contained. At this time it is unknown who will handle the cleanup.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stopped, ContainedYesCanalNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 550 Canal St.
b. CITY:c. COUNTY: d. ZIP:
San Rafael
Marin County94903BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/15/20230700 Road Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoYes
Fatals #: 2		NoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept.
d. ADMIN. AGENCY: Marin County Waste Management Officee. SEC. AGENCY: Marin County Communications Center
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

2
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, COASTAL COM, CDPH-D.O., EB PARKS, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-5957 *********

Created by: Warning Center on: 09/16/2023 11:04:21 AM Last Modified by: Warning Center on: 09/16/2023 11:18:49 AM