Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 05/09/2024
    TIME: 1543
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-2683
    NRC - 1398523
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
XXX
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. SWIMMING POOL PAINT=Unknown UnknownCHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC: THE CALLER IS REPORTING A RELEASE OF SWIMMING POOL PAINT, ONTO THE GROUND AND INTO STORM DRAIN. THE CALLER STATES THE CAUSE OF THE RELEASE IS UNKNOWN. THE CALLER ALSO STATES THAT THE CREW ON SITE WAS WASHING THE MATERIAL INTO A NEARBY STORM DRAIN.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedYesStorm drainUnknown
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 22542 KILLY ST
b. CITY:c. COUNTY: d. ZIP:
Lake Forest(1)
Orange County92630SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
05/09/20241300 Residence Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
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, CDPH-D.O., DWP-DO, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-2683 *********

Created by: Warning Center on: 05/09/2024 03:43:18 PM Last Modified by: Warning Center on: 05/09/2024 03:51:25 PM