Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 08/07/2024
    TIME: 1815
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4460
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Emergency Response and Training Solutions (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. MasterPozzolith 322 (concrete mix) =16-20 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the Reporting Party : During a pumping operation from a tank to a customers container a rupture occurred in the transfer hose for unknown reason causing a release of the material onto the asphalt; no waterways or storm drains were affected. The release was stopped by stopping flow to the hose. Absorbent material and sheeting was used to contain the spill. A contractor will be handling clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 790 Stockton Ave - Central Concrete Supply Company
b. CITY:c. COUNTY: d. ZIP:
San Jose
Santa Clara County95126BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
08/07/20241721 Merchant/Business 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: Santa Clara County Department of Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

2
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, CDPH-D.O., Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4460 *********

Created by: Warning Center on: 08/07/2024 06:15:48 PM Last Modified by: Warning Center on: 08/07/2024 06:30:31 PM