Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/02/2022
    TIME: 2050
    RECEIVED BY:
    CONTROL#:
    Cal OES - 22-5810
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
City of Auburn Fire Department
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. Coolant, Engine=2 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A passenger vehicle left the roadway and struck a telephone pole at or near the listed location. The collision resulted in damage to the vehicle's cooling system. Coolant was released onto the ground and into a nearby ditch/ channel. The Auburn police and fire departments are on-scene. No fires or injuries were reported. An environmental specialist is en route to assist with the cleanup. An investigation is ongoing.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesDitch (ground/ soil)No
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: State Route 49 & Chana Drive
b. CITY:c. COUNTY: d. ZIP:
Auburn
Placer County95603PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/02/20222035 Merchant/Business Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept.None
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, DFW-OSPR, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-5810 *********

Created by: Warning Center on: 10/02/2022 08:50:04 PM Last Modified by: Warning Center on: 10/02/2022 09:27:55 PM