Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/29/2021
TIME: 1601
RECEIVED BY: CONTROL#:
Cal OES - 21-6779
NRC - 1323154
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
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. Raw Sewage=Unknown Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: PER NRC,

THE CALLER STATED THAT A PRIVATE RESIDENCE IS RELEASING RAW SEWAGE ONTO THE GROUND AND INTO A NEARBY SEWAGE SYSTEM. THE AMOUNT OF MATERIAL THAT RELEASED IS CURRENTLY UNKNOWN. NOTIFIED THE SANITATION DEPARTMENT.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stoppedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 173 RUBICON CIRCLE
b. CITY:c. COUNTY: d. ZIP:
Danville
Contra Costa County94526BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/29/20211530 Residence Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Contra Costa County Health Services Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

2
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-6779 *********

Created by: Warning Center on: 11/29/2021 04:01:50 PM Last Modified by: Warning Center on: 11/29/2021 04:43:09 PM