Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/04/2024
    TIME: 2042
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5000
    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. Hydrogen Peroxide=2 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per the Reporting Party : A box containing 4 (1) gallons jugs of the product tipped over inside a van during transit causing the release of material onto the floor of the van. The release has been stopped. The release is contained inside the van; no waterways affected. The van is currently parked at a Fed Ex Distribution Facility. A contractor is in route to provide clean up.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 177 Parr Blvd
b. CITY:c. COUNTY: d. ZIP:
Richmond
Contra Costa County95801BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/04/20242019 Other
Description for Other : Contained to vehicle		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: Contra Costa County Health Services Departmente. 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, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5000 *********

Created by: Warning Center on: 09/04/2024 08:42:49 PM Last Modified by: Warning Center on: 09/04/2024 08:55:43 PM