Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 05/16/2024
    TIME: 0849
    RECEIVED BY:
    CONTROL#:
    Cal OES -
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Delete
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. Delete=Delete N/AOTHERDeleteNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Delete
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION:
b. CITY:c. COUNTY: d. ZIP:
Delete
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/16/20240800 Other
Description for Other : Delete
Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: e. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

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

Created by: Warning Center on: 05/16/2024 08:49:32 AM Last Modified by: Warning Center on: 05/23/2024 03:03:50 PM