Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 04/13/2021
TIME: 2001
RECEIVED BY: CONTROL#:
Cal OES - 21-1961
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Santa Clara City Fire Department
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. Raw Sewage<100 Gal(s)SEWAGENoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP states a resident at a mobile living site illegally dumped sewage from their RV into a storm drain. Has been stopped and contained with waterways impacted.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm drain
l. MARITIME VESSEL
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 2653 Gamblin Dr
b. CITY:c. COUNTY: d. ZIP:
Santa Clara
Santa Clara CountyBAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
04/13/20211921 Residence Other
Description for Other : Illegal Dumping
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
d. ADMIN. AGENCY: Santa Clara City Fire Departmente. SEC. AGENCY: Santa Clara County Department of Environmental Health
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
i. Cal GEM:
j. RWQCB Unit:

2
k. Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFG-OSPR, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
AA/CUPA; DTSC; RWQCB; US EPA; USFWS; DFG-OSPR; LANDS; PARKS & REC; Co/WP; Co/Hlth; Co/E-Hlth

Photo Attachment:
11. Cal OES Reg.
********* Control No: 21-1961 *********

Created by: Warning Center on: 04/13/2021 08:01:50 PM Last Modified by: Warning Center on: 04/13/2021 08:10:49 PM