Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 10/01/2022
TIME: 2134
RECEIVED BY: CONTROL#:
Cal OES - 22-5795
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. Fuel, gasoline=32 Oz.PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: It was determined a customer's fuel tank had a hole in it which resulted in a gasoline spill during a fuel refill. No fires or injuries were reported and no waterways were impacted. On-site personnel conducted a cleanup without incident.
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: 901 West Cutting Boulevard
b. CITY:c. COUNTY: d. ZIP:
Richmond
Contra Costa County94804BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/01/20220940 Service Station Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
None
d. ADMIN. AGENCY: Contra Costa County Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

2
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-5795 *********

Created by: Warning Center on: 10/01/2022 09:34:28 PM Last Modified by: Warning Center on: 10/01/2022 10:04:58 PM