Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/29/2024
    TIME: 2020
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6122
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Premium Environmental Services
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. UN 1263 Paint=2 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: The reporting party states that a trailer stopped at a truck stop when they noticed a release of the reported substance from the trailer onto the asphalt at the given location. The release has been stopped and contained. No waterways have been impacted. A contractor will conduct the cleanup.
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: 787 Montague Rd
b. CITY:c. COUNTY: d. ZIP:
Yreka
Siskiyou County96097SISKIYOU COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/29/20241956 Other
Description for Other : Truck Stop
Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Siskiyou County Environmental Healthe. 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
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6122 *********

Created by: Warning Center on: 10/29/2024 08:20:48 PM Last Modified by: Warning Center on: 10/29/2024 08:30:19 PM