Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 07/24/2021
TIME: 1627
RECEIVED BY: CONTROL#:
Cal OES - 21-3966
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. Mineral Oil (Non PCB) =1 Qt.(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states a transformer failed due to a mechanical failure causing a release onto concrete and vegetation. Stopped and contained with no waterways impacted. Contractor is enroute to conduct cleanup.
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: 111 Mayfair St
b. CITY:c. COUNTY: d. ZIP:
Willow Creek
Humboldt County95573NORTH COAST UNIFIED AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/24/20211530 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
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, PUC, Co/WP
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-3966 *********

Created by: Warning Center on: 07/24/2021 04:27:22 PM Last Modified by: Warning Center on: 07/24/2021 04:37:02 PM