Governor's Office Emergency Services |
TIME: 0831 |
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Cal OES - 23-7391 NRC - |
1. NAME: | 2. AGENCY: | 3. PHONE#: | 4. Ext: | 5. PAG/CELL: |
![]() | ERTS | ![]() | ![]() | ![]() |
1. NAME: | 2. AGENCY: | 3. PHONE#: | 4. Ext: | 5. PAG/CELL: |
![]() | ABC Supply | ![]() | ![]() | ![]() |
2. a. SUBSTANCE: | b.QTY:>=< | Amount | Measure | c. TYPE: | d. OTHER: | e. PIPELINE | f. VESSEL >= 300 Tons |
1. High-Solids Silicone 412 | = | 20 | Gal(s) | CHEMICAL | No | No | |
2. | = | No | No | ||||
3. | = | No | No |
g. DESCRIPTION: | Per Reporting Party do to human error approximately 20 gallons of High-Solids Silicone 412 released onto the asphalt parking lot, no waterways were impacted. A contractor will be hired to complete spill mitigation. | ||
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h. STOPPAGE/CONTAINMENT: | i. WATER INVOLVED: | j. WATERWAY: | k. DRINKING WATER IMPACTED |
Stopped, Contained | No | None | No |
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l. MARITIME VESSEL No | ![]() | m. KNOWN IMPACT None | ![]() |
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3. a. INCIDENT LOCATION: 7600 Madison Ave | |||
b. CITY: | c. COUNTY: | d. ZIP: | ![]() |
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Fair Oaks | Sacramento County | 95628 | SACRAMENTO METROPOLITAN AQMD |
4. INCIDENT DESCRIPTION: | |||
a. DATE: | b. TIME (Military): | c. SITE: | d. REPORTED CAUSE |
12/01/2023 | 0700 | Merchant/Business | Human Error |
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e. INJURIES | f. FATALITY | g. EVACUATION | h. CLEANUP BY: |
No | No | No | Contractor |
6. NOTIFICATION INFORMATION: | ||
a. ON SCENE: | b. OTHER ON SCENE: | c. OTHER NOTIFIED: |
d. ADMIN. AGENCY: Sacramento County Environmental Management | ![]() | e. SEC. AGENCY: |
f. ADDITIONAL COUNTY: | ![]() | g. ADMIN. AGENCY: |
h. NOTIFICATION LIST: | ![]() | ![]() |
Cal GEM: | RWQCB Unit: | 5B |
Cal OES Region: | ![]() | |
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Photo Attachment: | ![]() |