Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 05/19/2019
TIME: 1234
RECEIVED BY: CONTROL#:
Cal OES - 19-3237
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
PG&E
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. Mineral Oil, Non PCB=10 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the caqller a pole fire caused the release.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. KNOWN IMPACTNone
3. a. INCIDENT LOCATION: Lerdo Hwy
b. CITY:c. COUNTY: d. ZIP:
Buttonwillow
Kern CountySAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/18/20192300 Other
Description for Other : Rural Area
Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
d. ADMIN. AGENCY: Kern Co. Environmental Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
i. RWQCB Unit:
5C
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
********* Control No: 19-3237 *********

Created by: Warning Center on: 05/19/2019 12:34:35 PM Last Modified by: Warning Center on: 05/19/2019 12:39:49 PM