Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/20/2023
    TIME: 1244
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-6037
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
OG Packing
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. Ammonia - Anhydrous Type=25 Lbs.VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: During maintenance in a refrigeration room a coil was damaged causing the release, material vented inside the structure in a cold storage room, one employee was exposed and transported to a medical facility for treatment, approximately 80 subjects were evacuated and went home for the day, RP and FD handled the containment and vented the facility, no clean up is required.
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: 2097 Beyer Ln, D Building
b. CITY:c. COUNTY: d. ZIP:
Stockton
San Joaquin County95215SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/20/20231100 Merchant/Business Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 1		NoYes
Evacs #: 80		N/A
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., OtherEMSSJ Co EH
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, AIR RESOURCES BD, Co/WP
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-6037 *********

Created by: Warning Center on: 09/20/2023 12:44:23 PM Last Modified by: Warning Center on: 09/20/2023 12:57:41 PM