Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 08/02/2024
    TIME: 1705
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4379
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
3E Company
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. Thenol=.1 Liters(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, one of the employee's spilled approximately 100 ml of Thenol down the drain on accident in exam room 7. No more details are available at this time.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesDrainUnknown
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 3401 S Harbor Blvd
b. CITY:c. COUNTY: d. ZIP:
Santa Ana
Orange County92704SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/02/20241619 Merchant/Business Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnrecoverable
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: Santa Ana Fire Departmente. SEC. AGENCY: Orange County Emergency Management Division
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

8
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, DWP-DO, DPR, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4379 *********

Created by: Warning Center on: 08/02/2024 05:05:15 PM Last Modified by: Warning Center on: 08/02/2024 05:45:58 PM