Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/24/2023
    TIME: 0736
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-7259
    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. gasoline=8 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party: Gasoline leaked from a customer's tank while re-fueling, the car is currently being towed. Reporting party boomed off drains so spill only went onto cement. FD helped with clean up.
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: 2252 Lincoln Ave
b. CITY:c. COUNTY: d. ZIP:
San Jose
Santa Clara County95125BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/24/20230615 Service Station Other
Description for Other : Hole in gas tank
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoFire Dept.
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept.
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, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-7259 *********

Created by: Warning Center on: 11/24/2023 07:36:32 AM Last Modified by: Warning Center on: 11/24/2023 07:44:29 AM