Governor's Office Emergency Services
Hazardous Materials Spill Report |
DATE: 10/14/2024
TIME: 0757
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CONTROL#:
Cal OES -
NRC -
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1.a. PERSON NOTIFYING Cal OES:
1. NAME: | 2. AGENCY: | 3. PHONE#: | 4. Ext: | 5. PAG/CELL: |
| | | | |
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 | Measure | c. TYPE: | d. OTHER: | e. PIPELINE | f. VESSEL
>= 300 Tons |
1. | = | | | | | No | No |
2. | = | | | | | No | No |
3. | = | | | | | No | No |
g. DESCRIPTION: | |
| | | |
h. STOPPAGE/CONTAINMENT: | i. WATER INVOLVED: | j. WATERWAY: | k. DRINKING WATER IMPACTED |
| | | |
| | |
l. MARITIME VESSEL
| | m. KNOWN IMPACT
| |
| | | |
3. a. INCIDENT LOCATION: |
b. CITY: | c. COUNTY: | d. ZIP: | |
| | | |
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4. INCIDENT DESCRIPTION: |
a. DATE: | b. TIME (Military): | c. SITE: | d. REPORTED CAUSE |
| | | |
| | |
| | | |
e. INJURIES | f. FATALITY | g. EVACUATION | h. CLEANUP BY: |
No | No | No | |
6. NOTIFICATION INFORMATION: |
a. ON SCENE: | b. OTHER ON SCENE: | c. OTHER NOTIFIED: |
| | |
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment: | |
11. Cal OES Reg.
********* Control No: *********
Created by: Warning Center on: 10/14/2024 07:57:59 AM Last Modified by: Warning Center on: 10/14/2024 07:57:54 AM