Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 10/03/2022
TIME: 1530
RECEIVED BY: CONTROL#:
Cal OES - 22-5827
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 contractor struck a 1/2 inch service line with a back hoe, causing natural gas to be released into the atmosphere. The local fire department responded and no evacuations were necessary. Repair crews responded and the release was controlled at 1456 hours. 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
None
3. a. INCIDENT LOCATION: 4784 N. Lake Blvd.
b. CITY:c. COUNTY: d. ZIP:
Carnelian Bay
Placer County96140PLACER COUNTY APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/03/20221443 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: Placer County Environmental Healthe. 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/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-5827 *********

Created by: Warning Center on: 10/03/2022 03:30:06 PM Last Modified by: Warning Center on: 10/03/2022 03:38:58 PM