Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 03/27/2023
    TIME: 1532
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-2245
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Safeway - Environmental Manager
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<10 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Reporting Party states a sewage back-up caused an overflow into the store parking lot. A portion of the spill went into a storm drain. It is unknown where the storm drain leads. Repairs have been completed and containment measures deployed. A contractor has been hired to provide clean-up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm DrainNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 6498 Pony Express Trail
b. CITY:c. COUNTY: d. ZIP:
Pollock Pines
El Dorado County95726EL DORADO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
03/26/20230930 Merchant/Business Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: El Dorado County Environmental Managemente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, CDPH-D.O., LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-2245 *********

Created by: Warning Center on: 03/27/2023 03:32:34 PM Last Modified by: Warning Center on: 03/27/2023 03:42:00 PM