Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 06/22/2022
TIME: 0854
RECEIVED BY: CONTROL#:
Cal OES - 22-3524
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Cemex
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. Concrete wet mix =2 Yards N/AOTHERConcreteNoNo
2. Oil <1/2 Gal(s)PETROLEUMNoNo
3. = NoNo
g. DESCRIPTION: Caller states a redi mix cement truck flipped due to unknown reasons at this time. This caused a release of concrete mix and oil to spill onto asphalt. Release is stopped and contained with no waterways impacted. Cleanup crews have cleaned and cleared the area.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNo
l. MARITIME VESSEL
m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: HWY 101 North bound Matilda Right before HWY 237
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
06/21/20220700 Road Unknown
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 1
NoNoContractor
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Cal TransCUPA
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: 22-3524 *********

Created by: Warning Center on: 06/22/2022 08:54:02 AM Last Modified by: Warning Center on: 06/22/2022 09:18:25 AM