Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/11/2022
TIME: 1545
RECEIVED BY: CONTROL#:
Cal OES -
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Test
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. Test=Test N/AUNSPECIFIEDNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Warning Center is testing email generation. Delete after testing is complete.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Testing
b. CITY:c. COUNTY: d. ZIP:
Unincorporated county area Fresno
Fresno CountySAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/11/20221530 Road Other
Description for Other : Test
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoTest
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Fresno County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5C
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: *********

Created by: Warning Center on: 09/11/2022 03:45:52 PM Last Modified by: Warning Center on: 09/11/2022 03:50:58 PM