Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 02/03/2023
    TIME: 1812
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-0949
    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 Type=2-3 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: During customer vehicle fueling the pump shut off failed causing the release, material flowed onto concrete, on site personnel handled the containment and clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 15320 Bear Valley Rd, Chevron Fuel
b. CITY:c. COUNTY: d. ZIP:
Victorville
San Bernardino County92395MOJAVE DESERT AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
02/03/20231620 Service Station Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoOn site personnel
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Victorville Fire Departmente. SEC. AGENCY: San Bernardino County Fire Department
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

6B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-0949 *********

Created by: Warning Center on: 02/03/2023 06:12:06 PM Last Modified by: Warning Center on: 02/03/2023 06:30:30 PM