Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/29/2021
TIME: 1057
RECEIVED BY: CONTROL#:
Cal OES - 21-6769
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Groveland Community Services District
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, Raw=2,800 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states they were notified on 11/29/21 at 0845 hours of a Sanitary Sewer Overflow due to a blockage of grease and flushable wipes or rags, material overflowed from a manhole and into an unknown creek that leads to Pine Moutain Lake, the release is controlled and stopped as of 11/29/21 at 0945 hours, the blockage is cleared and everything is restored to normal, most of the material is unrecoverable, RP/SRP is handling cleanup, no drinking water source is impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, Not containedYesUnknown Creek, Pine Mountain Lake, No
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Behind 20018 Lower Skyridge Road
b. CITY:c. COUNTY: d. ZIP:
Groveland
Tuolumne County95321TUOLUMNE COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/26/20211500 Residence Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoResponsible Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Tuolumne County Environmental Divisione. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region: Inland
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, CDPH-D.O., CSWC Managers, LANDS, EDO, Cal OES REG, PARKS & REC, USCG, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg. jasen.vela@caloes.ca.gov, kyle.noderer@caloes.ca.gov
********* Control No: 21-6769 *********

Created by: Warning Center on: 11/29/2021 10:57:38 AM Last Modified by: Warning Center on: 11/29/2021 11:13:20 AM