Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 03/03/2021
TIME: 0856
RECEIVED BY: CONTROL#:
Cal OES - 21-1152
NRC - 1299490
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
National Response Center (NRC)
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
N/A
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Oil, unknown type=Unknown N/APETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC #1299490, "Caller reported that they witnessed oil releasing from a transformer onto the ground due to unknown causes. The caller witnessed the company trying to mitigate the release." REMEDIAL ACTIONS: Unknown. AFFECTED MEDIUM: Land/ concrete/ gravel
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. KNOWN IMPACTNone
3. a. INCIDENT LOCATION: 25406 Hagerman Road
b. CITY:c. COUNTY: d. ZIP:
Pioneer Station
Amador CountyAMADOR COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
03/02/20211000 Road Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoResponsible Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
NRC
d. ADMIN. AGENCY: Amador County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
i. Cal GEM:
j. RWQCB Unit:

5B
k. Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFG-OSPR, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-1152 *********

Created by: Warning Center on: 03/03/2021 08:56:34 AM Last Modified by: Warning Center on: 03/03/2021 09:11:36 AM