Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/25/2021
TIME: 1100
RECEIVED BY: CONTROL#:
Cal OES - 21-5272
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 N/AVAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states: A half inch service line was hit by a shovel resulting in the release of the material. The release is stopped and contained. No waterways were impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 542 Cayuga Circle
b. CITY:c. COUNTY: d. ZIP:
South Lake Tahoe
El Dorado County96150EL DORADO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/25/20210943 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.
d. ADMIN. AGENCY: El Dorado County Environmental Managemente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

6A
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: 21-5272 *********

Created by: Warning Center on: 09/25/2021 11:00:10 AM Last Modified by: Warning Center on: 09/25/2021 11:05:17 AM