Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/30/2022
TIME: 1036
RECEIVED BY: CONTROL#:
Cal OES - 22-5764
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
McDonalds
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. CO2=unknown N/AVAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Caller states that an unknown amount of CO2 was released into the atmosphere inside the building coming from 57 gallons tank in the basement due to an unknown cause; 20 people evacuated the building for safety precautions; FD responded on the scene and advised the evacuees that they are safe to go back in the building except the basement, caller chose not to enter the building until the technician will stop the source of the release.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Not stoppedNoNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 950 W Floral dr
b. CITY:c. COUNTY: d. ZIP:
Monterey Park
Los Angeles CountySOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/30/20220725 Merchant/Business Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoYes
Evacs #: 20
Unrecoverable
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
d. ADMIN. AGENCY: LACoFD Health Haz-Mate. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, CDPH-D.O., Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-5764 *********

Created by: Warning Center on: 09/30/2022 10:36:18 AM Last Modified by: Warning Center on: 09/30/2022 10:49:55 AM