Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/06/2024
    TIME: 0927
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6789
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
El Dorado Disposal
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. Transmission fluid=1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party: A plug fell out the transmission tank of the vehicle, causing a release of less than 1 gallon of transmission fluid along Mesa Verde Drive. No waterways were detected
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Mesa Verde Drive at Park Drive
b. CITY:c. COUNTY: d. ZIP:
El Dorado Hills
El Dorado CountyEL DORADO COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/05/20241130 Residence Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Environmental
d. ADMIN. AGENCY: El Dorado County Environmental Managemente. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-6789 *********

Created by: Warning Center on: 12/06/2024 09:27:36 AM Last Modified by: Warning Center on: 12/06/2024 09:38:08 AM