Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/17/2023
    TIME: 0951
    RECEIVED BY:
    CONTROL#:
    Cal OES - 23-5972
    NRC - 1379327
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
NRC
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
Private Citizen
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Herbicide=Unknown UnknownCHEMICAL, VAPORNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC Report "Caller is reporting a neighbor using a herbicide that causes health problems. No waterway impacted, unknown of the cleaning process."
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedNoN/ANo
l. MARITIME VESSEL
No		m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 34 E 21st Street
b. CITY:c. COUNTY: d. ZIP:
Tracy
San Joaquin CountySAN JOAQUIN VALLEY UNIFIED APCD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/17/20230930 Residence Other
Description for Other : Dumping
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoUnknown
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
d. ADMIN. AGENCY: San Joaquin County Environmental Healthe. SEC. AGENCY:
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

5B
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, AIR RESOURCES BD, CDPH-D.O., DPR, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 23-5972 *********

Created by: Warning Center on: 09/17/2023 09:51:13 AM Last Modified by: Warning Center on: 09/17/2023 10:08:42 AM