Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 05/30/2023
    TIME: 1134
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-3530
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
UCLA
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=2,000 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A sewage pump failed which caused the release, material flowed into a storm drain (Wilsher Blvd at 16th St), RP and contractor are handling the containment and clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm DrainNo
l. MARITIME VESSEL
m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 1250 16th St, UCLA Santa Monica Hospital
b. CITY:c. COUNTY: d. ZIP:
Santa Monica
Los Angeles County90404SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/30/20230745-1000 School Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
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, DFW-OSPR, COASTAL COM, CDPH-D.O., LANDS, PARKS & REC, USCG, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-3530 *********

Created by: Warning Center on: 05/30/2023 11:34:31 AM Last Modified by: Warning Center on: 05/30/2023 11:42:54 AM