Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/23/2024
    TIME: 0804
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-7136
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Private Citizen
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=4 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: ///Historical Report///Historical Report///Historical Report///
Per reporting party, On October 2, 2024, the reporting party was at a gas station when a mechanical failure occurred with the nozzle, causing at least 2 gallons of oil to spray onto his body and onto the concrete. The spill was cleaned up using a mop and bucket. The reporting party is experiencing injuries to his eyes and body. He notified relevant agencies, but no one has reached out to him. The CDFA conducted an investigation, which resulted in the gas station was found to have inoperative insertion interlock. A red tag and caution tape was placed on October 3rd. Was a section violation of CCR 4000.
///Historical Report///Historical Report///Historical Report///
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedNoNoneNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 5164 W. Washington Blvd
b. CITY:c. COUNTY: d. ZIP:
Los Angeles
Los Angeles County90016SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/02/20240652 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 1
NoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
OSHA, Department of Wights and Measures
d. ADMIN. AGENCY: Los Angeles City Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-7136 *********

Created by: Warning Center on: 12/23/2024 08:04:46 AM Last Modified by: Warning Center on: 12/23/2024 08:29:31 AM