Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 12/06/2022
TIME: 1519
RECEIVED BY: CONTROL#:
Cal OES - 22-7146
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
City of Santa Monica Water Resources Div
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 - Raw Type=85 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A main line blockage caused the release, material flowed from a floor drain into an interior laundry room , RP handled the containment, responsible party is performing clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 201 / 211 San Vicente Blvd, Apartment Building
b. CITY:c. COUNTY: d. ZIP:
Santa Monica
Los Angeles County90402SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/06/20221100-1400 Residence Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoResponsible Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
LA Co PH
d. ADMIN. AGENCY: City of Santa Monicae. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, CDPH-D.O.
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-7146 *********

Created by: Warning Center on: 12/06/2022 03:19:47 PM Last Modified by: Warning Center on: 12/06/2022 03:26:22 PM