Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/21/2022
TIME: 1244		RECEIVED BY: CONTROL#:
Cal OES - 22-6852
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Southwest Gas
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: A gas line was damaged by a water line break, causing Natural Gas to be released into the atmosphere. A crew responded and stopped the release at 1159 hours. The local fire department responded and no evacuations were required. The water company is on site for the water break. There is a road closure in effect the cul del sac of Algonquin Rd. No waterways impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, Not containedNoNoneNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Road Closure
3. a. INCIDENT LOCATION: 21475 Minodoka Rd.
b. CITY:c. COUNTY: d. ZIP:
Apple Valley
San Bernardino County92308MOJAVE DESERT AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/21/20221048 Residence Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnrecoverable
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Police Dept., OtherApple Valley Water Company
d. ADMIN. AGENCY: San Bernardino County Fire Departmente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

6B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-6852 *********

Created by: Warning Center on: 11/21/2022 12:44:13 PM Last Modified by: Warning Center on: 11/21/2022 01:04:28 PM