Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 06/03/2023
    TIME: 2016
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-3638
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Roseville Fire Dept
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. Diesel=15 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP States: Do to an solo accident a tractor trailer punctured one of its saddle tanks causing diesel to spill onto the roadway in the Sam Clubs parking lot, no waterways were impacted. Roseville Fire has initiated initial clean up and a contractor will complete clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 904 Pleasant Grove Blvd
b. CITY:c. COUNTY: d. ZIP:
Roseville
Placer County95678PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/03/20232000 Merchant/Business Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoFire Dept.
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
d. ADMIN. AGENCY: Roseville Fire Departmente. SEC. AGENCY: Placer County Environmental Health
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-3638 *********

Created by: Warning Center on: 06/03/2023 08:16:49 PM Last Modified by: Warning Center on: 06/03/2023 08:27:51 PM