Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/11/2024
    TIME: 1650
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6909
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Western Placer Waste Management Authority / Contractor
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. Diesel=1 Qt.(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Reporting Party: During refueling there was an accidental spill of 1 quart of diesel onto concrete. The diesel ran down into a storm drain that leads to a sand oil seperator, where it was contained. The spill is stopped and contained. No waterways were involved. Clean up has been conducted with absorbants.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 3033 Siddynent Road
b. CITY:c. COUNTY: d. ZIP:
Roseville
Placer County95747PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/10/20241155 hours Other
Description for Other : Landfill		Human Error
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: Roseville Fire Departmente. SEC. AGENCY: Placer County Environmental Health
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: 24-6909 *********

Created by: Warning Center on: 12/11/2024 04:50:37 PM Last Modified by: Warning Center on: 12/11/2024 05:01:40 PM