Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 07/08/2024
    TIME: 1341
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-3875
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Walmart
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. Anhydrous Ammonia=1 Lbs.VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party a failed o-ring in a solenoid plunger on a refrigeration unit caused the release of 1 lb of Anhydrous Ammonia to release into the atmosphere. This release has been stopped and contained but was unrecoverable.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 2701 South Driver RD
b. CITY:c. COUNTY: d. ZIP:
Shafter
Kern County93263SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/08/20240800 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnrecoverable
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Kern Co. Environmental Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5C
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-3875 *********

Created by: Warning Center on: 07/08/2024 01:41:09 PM Last Modified by: Warning Center on: 07/08/2024 01:53:48 PM