Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 09/26/2022
TIME: 1304
RECEIVED BY: CONTROL#:
Cal OES - 22-5653
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Santa Clara City FD
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. Coolant =1 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Due to a vehicle accident involving 2 sedans a release of one gallon of coolant was released onto the street with impacts to a dry storm drain. Spill has been stopped and contained and FD was on scene for spill mitigation with absorbent pads. 1 injury occurred due to the accident. Contractors are on scene to continue clean up and to recover spill from storm drain.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoStorm Drain No
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: Serra Ave / Los Padres Blvd
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
09/27/20221238 Road Collision
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 1
NoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police 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:
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: 22-5653 *********

Created by: Warning Center on: 09/26/2022 01:04:28 PM Last Modified by: Warning Center on: 09/26/2022 01:15:57 PM