Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 02/20/2024
    TIME: 0647
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-1051
    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. Non PCB Transformer Oil=1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party, high winds broke a pole that the equipment was mounted on causing the release. No storm drains or waterways impacted. A contractor will conduct the cleanup. The release occurred in a vineyard but only impacted the ground.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 8099 Doten Road
b. CITY:c. COUNTY: d. ZIP:
Kelseyville
Lake CountyLAKE COUNTY AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
02/19/20241157 Road Other
Description for Other : Inclement Weather
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Lake County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, FOOD & AG, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-1051 *********

Created by: Warning Center on: 02/20/2024 06:47:31 AM Last Modified by: Warning Center on: 02/20/2024 06:51:43 AM