Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 03/24/2023
    TIME: 1338
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-2177
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Circle K Stores Inc
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. Car Wash Soap=50 Gal(s)OTHERCar Wash SoapNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Reporting party states there was a mechanical failure inside their car wash causing the release of 50 gallons of car wash soap. The release has been stopped and contained. RP states 1 gallon may have made it into the storm drain but Circle K has an absorbing filter and pillow inside the storm drain which may have stopped the spill from going down the drain. Circle K environmental consultant is heading to the site.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm DrainNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 3470 Fairview Road
b. CITY:c. COUNTY: d. ZIP:
Costa Mesa
Orange CountySOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
03/24/20231100 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
d. ADMIN. AGENCY: Orange County Emergency Management Divisione. SEC. AGENCY:
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, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-2177 *********

Created by: Warning Center on: 03/24/2023 01:38:44 PM Last Modified by: Warning Center on: 03/24/2023 01:50:50 PM