Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/07/2023
    TIME: 1122
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-7510
    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 Mineral Oil<1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party: A n equipment failure caused an overhead transformer to release less than 1 gallon of non-pcb mineral oil onto a concrete sidewalk in a 3 feet x 3 feet radius. Cleanup has been conducted by a contractor and repairs have been made by PG&E personnel.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 145 Berkeley St
b. CITY:c. COUNTY: d. ZIP:
Rio Dell
Humboldt CountyNORTH COAST UNIFIED AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/30/20230830 Road Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
PG&E
d. ADMIN. AGENCY: Humboldt County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

1
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-7510 *********

Created by: Warning Center on: 12/07/2023 11:22:04 AM Last Modified by: Warning Center on: 12/07/2023 11:39:07 AM