Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/08/2024
    TIME: 1424
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5706
    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. Mold=Unknown N/ABIOMEDICALNoNo
2. Paint=Unknown N/ACHEMICALNoNo
3. = NoNo
g. DESCRIPTION: *** Historical Report, Historical Report, Historical Report ***

Per the reporting party, at the listed location, the reporting party experienced toxic exposure to mold and toxic paint at the facility. He is suffering from toxic affects from this exposure affecting his ability to walk. There is no clean-up. The exposure occurred in the past while the reporting party resided at the LA Family Housing community.

*** Historical Report, Historical Report, Historical Report ***
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedNoN/ANo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 7843 Lankershim Blvd, LA Family Housing
b. CITY:c. COUNTY: d. ZIP:
North Hollywood
Los Angeles County91605SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/01/20240645 Other
Description for Other : Homeless shelter
Other
Description for Other : Exposure to mold and toxic paint
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
EMS
d. ADMIN. AGENCY: Los Angeles City Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, CDPH-D.O., Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5706 *********

Created by: Warning Center on: 10/08/2024 02:24:54 PM Last Modified by: Warning Center on: 10/08/2024 02:46:12 PM