Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/11/2024
    TIME: 2217
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6358
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Nevada County Sanitation
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 =120 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, there was a blockage of a combination of flush-able wipes and grease causing a release of 120 gallons of sewage from a broken 6 inch pipe into a dry seasonal Creek. The release has been stopped and contained. Clean up was conducted by the reporting party, and managed to recover all of the sewage.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesSeasonal CreekNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 19117 Lake Forest Drive
b. CITY:c. COUNTY: d. ZIP:
Penn Valley
Nevada County95946NORTHERN SIERRA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/11/20241713 Residence Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Nevada County Environmental Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6358 *********

Created by: Warning Center on: 11/11/2024 10:17:18 PM Last Modified by: Warning Center on: 11/11/2024 10:43:31 PM