Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 10/12/2019
TIME: 1022
RECEIVED BY: CONTROL#:
Cal OES - 19-6567
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 contractor hit a 1/2 inch PE line resulting in the relase. The relase is stopped and contained. No waterways were impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
StoppedNoNo
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 809 South Shore Drive
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
10/12/20190925 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:
DOG Unit:
RWQCB Unit:

6A
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, Co/WP, Co/Hlth

Photo Attachment:
11. Cal OES Reg.
********* Control No: 19-6567 *********

Created by: Warning Center on: 10/12/2019 10:22:19 AM Last Modified by: Warning Center on: 10/12/2019 10:28:19 AM