Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/18/2023
    TIME: 1529
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-5990
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
OERM
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Cisco Systems
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Chilled water=1000 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Caller " Problem with in-line flow meter was cracked and damaged which resulted in the release of chilled water with a corrosion inhibitor C-4710 which contains sodium nitrite on to concrete and vegetation. Clean Harbors contractor are en route for the clean up process. Potential to enter city's storm drain system, it has enter the buildings storm drain. It has been stopped and contained-pooled in the back of building."
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesBuildings storm drain systemUnknown
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 3850 Zanker Rd
b. CITY:c. COUNTY: d. ZIP:
San Jose
Santa Clara County95134BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/18/20231340 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
City of San Jose
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: Coastal
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, COASTAL COM, CSWC Managers, DWP-DO, LANDS, EDO, FDC, Cal OES REG, LDO, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg. melanie.gilbert@caloes.ca.gov
********* Control No: 23-5990 *********

Created by: Warning Center on: 09/18/2023 03:29:24 PM Last Modified by: Warning Center on: 09/18/2023 04:02:15 PM