Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/30/2021
TIME: 0737
RECEIVED BY: CONTROL#:
Cal OES - 21-6791
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
CHP Bishop
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. Fuel - Diesel Type=25-50 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A solo pick up truck roll over caused the release, material flowed onto soil, unknown who is handling the containment and clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: SB Sierra Hwy JNO of Dawn Rd
b. CITY:c. COUNTY: d. ZIP:
Mojave
Kern County93501KERN COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/30/20210638 Road Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CHP
d. ADMIN. AGENCY: Kern Co. Environmental Health Services 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, CHP, Co/WP
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-6791 *********

Created by: Warning Center on: 11/30/2021 07:37:01 AM Last Modified by: Warning Center on: 11/30/2021 07:42:22 AM