Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 08/31/2024
    TIME: 2103
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4945
    NRC - 1409614
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
National Response Center (NRC)
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Private citizen
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Oil, Unknown type=Unknown N/APETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: ***Potential Release*** Per NRC #1409614, "Caller is reporting a potential spill of automotive fluids due to a pick-up truck that went into the water when placing a jet ski in the water at the incident location." ***Potential Release***
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedYesLake HavasuNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 156100 Black Meadow Road
b. CITY:c. COUNTY: d. ZIP:
Unincorporated county area San Bernardino Northern area
San Bernardino CountyMOJAVE DESERT AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/31/20241830 Waterways Other
Description for Other : Loss of vehicle control
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
NRC
d. ADMIN. AGENCY: San Bernardino County Fire Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

6B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4945 *********

Created by: Warning Center on: 08/31/2024 09:03:58 PM Last Modified by: Warning Center on: 08/31/2024 09:19:07 PM