Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/06/2024
    TIME: 1649
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5041
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Private Citizen
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=Unknown UnknownSEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, they have indicated that less than 100 gallons of septic overflow have been spilling onto the property. The property management has hosed it down, directing it to a storm drain that eventually leads to other waterways. This has been an ongoing issue for the past six years and has caused damage to her home and is not safe for them as senior citizen.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stoppedYesStorm drain No
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 10755 Mobile Village Way Spc 80
b. CITY:c. COUNTY: d. ZIP:
Willits
Mendocino County95490MENDOCINO COUNTY AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/22/20240900 Refinery Overflow
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Mendocino County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

1
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, CDPH-D.O., LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5041 *********

Created by: Warning Center on: 09/06/2024 04:49:28 PM Last Modified by: Warning Center on: 09/06/2024 05:01:29 PM