Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 12/05/2024
    TIME: 1152
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-6770
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
3E Company
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
CostCo
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Antifreeze=2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Reporting Party: A vendor delivery truck blew a line at the loading dock of a CostCo. The release was 2 gallons of Antifreeze onto the concrete. Roughly a pint of it is estimated to have entered a storm drain and caught in the catch basin. The spill is stopped and contained. The store workers cleaned up the spill and a company Hazmat team is enroute.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 25501 South Gateway, Building A
b. CITY:c. COUNTY: d. ZIP:
Tracy
San Joaquin County95377SAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
12/05/20241000 Merchant/Business Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
San Joaquin County Environmental Health
d. ADMIN. AGENCY: San Joaquin County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
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: 24-6770 *********

Created by: Warning Center on: 12/05/2024 11:52:02 AM Last Modified by: Warning Center on: 12/05/2024 02:01:08 PM