Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 08/08/2024
    TIME: 1421
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4483
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Washington Hospital
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. Formula 3080 <1 Gal(s)CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: ***Historical Report***
Per reporting party, a barrel that was used to clean pipes had a crack on the bottom and released less then a gallon of chlorine. The release did go down into the drain system where it was stopped and contained. Two staff members had affects from the chlorine and where treated in a emergency room. The release has been cleaned up using dry sweep and was disposed of properly. Clean Harbors was notified and conducted additional cleaning and transported in a disposable bin for proper disposal.
***Historical Report***
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesDrain SystemNo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 2000 Mowry Ave
b. CITY:c. COUNTY: d. ZIP:
Fremont
Alameda County94538BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
06/12/20241100 Merchant/Business Other
Description for Other : Damaged Equipment
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 2		NoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
CUPA
d. ADMIN. AGENCY: Fremont City Fire Departmente. SEC. AGENCY: Alameda County 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, DFW-OSPR, AIR RESOURCES BD, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4483 *********

Created by: Warning Center on: 08/08/2024 02:21:53 PM Last Modified by: Warning Center on: 08/08/2024 02:37:26 PM