Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 08/04/2022
TIME: 1224
RECEIVED BY: CONTROL#:
Cal OES - 22-4458
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Monterey City FD
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 Type=65 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A possible lateral line blockage caused the release, material flowed onto asphalt, FD handled containment, City of Pacific Grove and contractor performed clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 1212 Forest Ave
b. CITY:c. COUNTY: d. ZIP:
Pacific Grove
Monterey County93950MONTEREY BAY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/04/20221145 Residence Blockage
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoCity of Pacific Grove
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept.City of Pacific GroveMonterey Co Health
d. ADMIN. AGENCY: Monterey County Health Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

3
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-4458 *********

Created by: Warning Center on: 08/04/2022 12:24:26 PM Last Modified by: Warning Center on: 08/04/2022 12:31:07 PM