Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/12/2024
    TIME: 1901
    RECEIVED BY:
    CONTROL#:
    Cal OES -
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
delete
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. delete=Unknown UnknownSEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: delete
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stopped, Not containedYesStorm DrainNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: delete
b. CITY:c. COUNTY: d. ZIP:
Delete
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/12/20241705 Road Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., OtherContracted Responder
d. ADMIN. AGENCY: Marin County Waste Management Officee. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: *********

Created by: Warning Center on: 10/12/2024 07:01:24 PM Last Modified by: Warning Center on: 10/26/2024 11:13:26 PM