Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 09/10/2024
    TIME: 1611
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-5114
    NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
City of Cupertino
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. Potable Water=Unknown UnknownOTHERPotable WaterNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per reporting party, water line broke under a private street, releasing an unknown amount of potable water to surface and flow into several storm drains and into Calabasas Creek. Repairs are currently underway, and the responsible party will oversee the cleanup process.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedYesStorm Drain / Calabasas CreekYes
l. MARITIME VESSEL
No		m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 18922 Forge Drive
b. CITY:c. COUNTY: d. ZIP:
Cupertino
Santa Clara County95014BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
09/10/20241230 Merchant/Business Broken Pipe
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoResponsible 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, DWP-DO, LANDS, PARKS & REC, Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-5114 *********

Created by: Warning Center on: 09/10/2024 04:11:10 PM Last Modified by: Warning Center on: 09/10/2024 04:29:11 PM