Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/25/2021
TIME: 0137
RECEIVED BY: CONTROL#:
Cal OES - 21-5268
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Southern California Edison (SCE)
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)=40 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Car struck a pad mount transformer resulting in the release of the substance onto the soil, concrete and into a gutter. No waterways impacted.
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: 12590 Cobalt Road
b. CITY:c. COUNTY: d. ZIP:
Victorville
San Bernardino CountyMOJAVE DESERT AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/25/20210110 Residence Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept.
d. ADMIN. AGENCY: Victorville Fire Departmente. SEC. AGENCY: San Bernardino County Fire Department
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, Co/WP
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-5268 *********

Created by: Warning Center on: 09/25/2021 01:37:06 AM Last Modified by: Warning Center on: 09/25/2021 01:42:15 AM