Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 11/21/2023
    TIME: 1102
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-7224
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Clean Harbors Environmental
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. New Motor Oil =50 Gal(s)PETROLEUMNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per Reporting Party : A crack developed in a 330 gallon tote being transported in the back of a box truck causing a release of approximately 50 gallons of new motor oil into the back of the truck; approximately 15 gallons made it out of the truck and onto the asphalt/street. The leak was stopped and absorbent material was deployed to contain the spill; no waterways were impacted. Reporting party is handling clean up. No road closures.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoN/ANo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 575 Vermont Street - Sunrise Forklift
b. CITY:c. COUNTY: d. ZIP:
San Jose
Santa Clara County95110BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
11/21/202310:30 Road Mechanical
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
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/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-7224 *********

Created by: Warning Center on: 11/21/2023 11:02:47 AM Last Modified by: Warning Center on: 11/21/2023 11:14:37 AM