Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 06/06/2023
    TIME: 0041
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-3685
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Sacramento Regional Waster Water Treatment
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. Core Shield MD 4100<1 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states, A mechanical failure on a hot water pump caused the release of less than 1 gallon of Core Shield MD 4100 from the seal. The release has been stopped and has been isolated. No waterways or storm drains were impacted. The reporting party will be conducting cleanup of the release.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 8521 Laguna Station Rd.
b. CITY:c. COUNTY: d. ZIP:
Elk Grove
Sacramento County95758SACRAMENTO METROPOLITAN AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/06/20230020 Treatment/Sewage Facility Mechanical
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: Sacramento County Environmental Managemente. 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/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-3685 *********

Created by: Warning Center on: 06/06/2023 12:41:00 AM Last Modified by: Warning Center on: 06/06/2023 12:47:01 AM