Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/29/2024
    TIME: 0915
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-7222
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
ERTS
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. Gasoline (Premium) =20 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the Reporting Party: During a fuel transfer from a tanker truck to an underground fuel storage tank at a 7-11 store/service station the transfer hose came loose from the truck due to unknown reason causing the release of gasoline onto the surrounding concrete area. No waterways or storm drains were affected. The release was stopped. A contractor is in route to the location for clean up. Employees on site did not mention any efforts taken by them to contain the release.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, Unknown if containedNoN/ANo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 204 East 17th Street
b. CITY:c. COUNTY: d. ZIP:
Costa Mesa
Orange County92627SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/29/20240815 Service Station Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CUPA
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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-7222 *********

Created by: Warning Center on: 12/29/2024 09:15:09 AM Last Modified by: Warning Center on: 12/29/2024 09:27:29 AM