Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 07/11/2024
    TIME: 1234
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-3960
    NRC - 1404402
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Enso Village
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Freon - Refrigerator Gases=Unknown UnknownVAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC Report: The caller reported a release of an unknown amount of freon from an A/C unit inside the main kitchen of a senior living facility at the incident location. The cause of the release is due to a worker accidentally cutting a line on the A/C unit. Remedial Actions: Exposure reports have been conducted. Release Secured: Yes
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 1801 Boxheart Dr
b. CITY:c. COUNTY: d. ZIP:
Healdsburg
Sonoma County95448NORTHERN SONOMA COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/11/20240745 Other
Description for Other : Senior Living Facility		Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoYes
Evacs #: 12		Unknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CA Dept of Health
d. ADMIN. AGENCY: Healdsburg Fire Departmente. SEC. AGENCY: Sonoma County Fire Services Department
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

1
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-3960 *********

Created by: Warning Center on: 07/11/2024 12:34:02 PM Last Modified by: Warning Center on: 07/11/2024 12:44:51 PM