Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/09/2024
    TIME: 1551
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6322
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Jacob Engineering
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. Sewage=100 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the reporting party, on 11/09/2024 at approximately 1230 in the afternoon, roots caused a blockage in a 6 inch diameter old clay line. This caused the release of the listed sewage. The sewage overflow was stopped at 1345 in the afternoon. The spill impacted a dirt hillside and remained contained within the dirt. Jacob Engineering personnel cleared the blockage and performed the clean-up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Road Closure
3. a. INCIDENT LOCATION: 12750 Shockley Court
b. CITY:c. COUNTY: d. ZIP:
Auburn
Placer County95603PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/09/20241230 Residence Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Placer County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6322 *********

Created by: Warning Center on: 11/09/2024 03:51:08 PM Last Modified by: Warning Center on: 11/09/2024 04:07:01 PM