Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 05/13/2024
    TIME: 1313
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-2737
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
San Rafael Sanitation District
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=362.89 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: The reporting party states that there was a blockage in the sewer main line causing the release of 362.89 gallons of sewage. The release impacted a storm drain. The release is stopped and contained. The reporting party will conduct the clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm DrainNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 271 Clorinda Ave
b. CITY:c. COUNTY: d. ZIP:
San Rafael
Marin County94901BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/13/20241117 Residence Blockage
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: Marin County Waste Management Officee. SEC. AGENCY: Marin County Communications Center
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

2
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-2737 *********

Created by: Warning Center on: 05/13/2024 01:13:43 PM Last Modified by: Warning Center on: 05/13/2024 01:26:16 PM