Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 10/21/2024
    TIME: 1228
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5960
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Roseville Fire Department
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. Natural Gas =Unknown Lbs.VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Caller stated due to human error a 2 inch plastic service line was ruptured with a backhoe which caused a release of natural gas. Release has not been stopped and is not contained with no waterways impacted. Control time of the release was 1240 hours.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stopped, Not containedNoNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 9466 Moondancer Cir
b. CITY:c. COUNTY: d. ZIP:
Roseville
Placer County95747PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/21/20241210 Residence Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnrecoverable
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.PG&E
d. ADMIN. AGENCY: Roseville Fire Departmente. SEC. AGENCY: Placer County Environmental Health
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5960 *********

Created by: Warning Center on: 10/21/2024 12:28:02 PM Last Modified by: Warning Center on: 10/21/2024 12:42:06 PM