Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/15/2024
    TIME: 1420
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5833
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Canyon Lake POA
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. Concrete =25 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, due to new construction concrete was released and went down a hill and made impacts into a storm drain. Release has been stopped and reporting party conducted clean up from the storm drain. No further impacts have been reported due to this incident.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesCanyon Lake / Lake Elsinore Yes
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 22610 Canyon Lake Dr
b. CITY:c. COUNTY: d. ZIP:
Canyon Lake
Riverside County92587SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/15/20241134 Residence Human Error
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: Riverside County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

8
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, LANDS, PARKS & REC, USCG, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5833 *********

Created by: Warning Center on: 10/15/2024 02:20:00 PM Last Modified by: Warning Center on: 10/15/2024 02:32:27 PM