Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/17/2015
TIME: 0521
RECEIVED BY: CONTROL#:
Cal OES - 15-5477
NRC - 1128697
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
USN - USS WILLIAM P. LAWRENCE
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. AFFF Fire Fighting Foam=30 Ft x 15 Ft SheenUNSPECIFIEDNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: PER NRC: "CALLER IS REPORTING THE DISCHARGE OF AFFF FIREFIGHTING FOAM INTO THE HARBOR DUE TO UNKNOWN CAUSES. REMEDIAL ACTIONS: BOOM APPLIED."
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
UnknownYesPacific OceanNo
m. KNOWN IMPACT
3. a. INCIDENT LOCATION: 3985 CUMMINGS ROAD
b. CITY:c. COUNTY: d. ZIP:
San Diego
San Diego County92136SAN DIEGO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/16/20151900 Ship/Harbor/Port Unknown
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 Diego County Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
RWQCB Unit:

9
Cal OES Region:
AA/CUPA, DFG-OSPR, DTSC, RWQCB, US EPA, USFWS, COASTAL COM, LANDS, PARKS & REC, USCG, Co/WP, Co/E-Hlth
AA/CUPA; DFG-OSPR; DTSC; RWQCB; US EPA; USFWS; COASTAL COM; LANDS; PARKS & REC; USCG; Co/WP; Co/E-Hlth

Photo Attachment:
11. Cal OES Reg.
********* Control No: 15-5477 *********

Created by: Warning Center on: 09/17/2015 05:21:39 AM Last Modified by: Warning Center on: 09/17/2015 05:29:45 AM