Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 12/06/2022
TIME: 1632
RECEIVED BY: CONTROL#:
Cal OES - 22-7149
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Cloverdale KOA
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. Coliform =Unknown UnknownOTHERBacteriaNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Caller stated they took a sample from a kitchen faucet that gets its water from a well and it tested positive for Coliform but negative for E Coli. Cause of release and amount was unknown.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedYesWell Yes
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Wreck Hall Building
b. CITY:c. COUNTY: d. ZIP:
Cloverdale
Sonoma CountyNORTHERN SONOMA COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/05/20221100 Waterways Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Sonoma County Fire Services 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, DFW-OSPR, CDPH-D.O., FOOD & AG, PARKS & REC, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-7149 *********

Created by: Warning Center on: 12/06/2022 04:32:57 PM Last Modified by: Warning Center on: 12/06/2022 04:51:55 PM