Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 08/29/2024
    TIME: 1135
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4886
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Private Citizen
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=Unknown UnknownSEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, this is an ongoing incident involving an unknown quantity of a black substance, possibly sewage, leaking from a restroom at the rear of the location. The release has not yet been stopped or contained, and no waterways have been impacted at this time. However, it could pose a potential hazard to the environment. There are three separate streams on the property, but none have been affected so far.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stopped, Not containedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 3489 Goodman Ranch Rd
b. CITY:c. COUNTY: d. ZIP:
Garberville
Humboldt County95542NORTH COAST UNIFIED AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/29/20241100 Residence Overflow
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Humboldt 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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4886 *********

Created by: Warning Center on: 08/29/2024 11:35:27 AM Last Modified by: Warning Center on: 08/29/2024 12:13:36 PM