Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 10/01/2022
TIME: 2132
RECEIVED BY: CONTROL#:
Cal OES - 22-5794
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Chevron
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. Fuel, gasoline=2 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: A customer overfilled the fuel tank of their vehicle causing a gasoline spill to the concrete pad of the service station. No fires or injuries were reported and no waterways were impacted. On-site personnel completed a cleanup without incident.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 1704 Saratoga Avenue
b. CITY:c. COUNTY: d. ZIP:
San Jose
Santa Clara County95129BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/30/20220852 Service Station Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
None
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, DFW-OSPR, Co/WP, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-5794 *********

Created by: Warning Center on: 10/01/2022 09:32:03 PM Last Modified by: Warning Center on: 10/01/2022 09:53:22 PM