Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/05/2023
    TIME: 1500
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-7468
    NRC - 1385957
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron
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. Regular Gasoline=2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Reporting Party: A customer was refueling thier vehicle and the pump nozzle did not shut off due to a mechanical issue. This caused fuel to spill onto the gas stations pavement and into a collection drain. No water ways were impacted and the spill has been stopped and contained.

Per NRC Report: REGULAR GASOLINE RELEASED FROM A NOZZLE AT THE DISPENSER DUE TO AN EQUIPMENT MALFUNCTION. REMEDIAL ACTIONS: EMPLOYEES CONTAINED THE SPILL WITH ABSORBENT AND COMPLETED THE CLEANUP. DISPATCHED CONTRACTOR.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 3801 South Bristol Street
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
12/05/20231515 Service Station Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
NRC, OCEH
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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-7468 *********

Created by: Warning Center on: 12/05/2023 03:00:44 PM Last Modified by: Warning Center on: 12/05/2023 03:31:12 PM