Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 01/22/2020
TIME: 1516
RECEIVED BY: CONTROL#:
Cal OES - 20-0440
NRC - 1269319
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Camp Pendleton
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. Aqueous Film Forming Foam (AFFF) 3%=120 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP advised that during maintenance of some new equipment, a hose became disconnected, due to an unknown reason, causing the release of Aqueous Film Forming Foam (AFFF) 3% to drain out of the hose and into a nearby storm drain. AFFF did not make it to the out fall of the storm drain and was able to recovered in its entirety. No waterways were affected.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Camp Pendleton, Building 22158
b. CITY:c. COUNTY: d. ZIP:
Camp Pendleton
San Diego County92055SAN DIEGO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
01/22/20200600 Military Base Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
NRC
d. ADMIN. AGENCY: San Diego County Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
DOG Unit:
RWQCB Unit:

9
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFG-OSPR, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
AA/CUPA; DTSC; RWQCB; US EPA; USFWS; DFG-OSPR; LANDS; PARKS & REC; Co/WP; Co/Hlth; Co/E-Hlth

Photo Attachment:
11. Cal OES Reg.
********* Control No: 20-0440 *********

Created by: Warning Center on: 01/22/2020 03:16:06 PM Last Modified by: Warning Center on: 01/22/2020 03:37:48 PM