Governor's Office Emergency Services
Hazardous Materials Spill Report

    DATE: 07/18/2024
    TIME: 1359
    RECEIVED BY:
    CONTROL#:
    Cal OES - 24-4113
    NRC - 1405205
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. Mercury=Unknown UnknownCHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: Per NRC Report: Caller reported that while taking a temperature, thermometer accidentally broke releasing mercury onto the carpet. Remedial Actions: Caller tried to clean it up with a vacuum.

h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Unknown if stopped, Unknown if containedNoNoneNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
Unknown
3. a. INCIDENT LOCATION: 405 Palmcrest Dr
b. CITY:c. COUNTY: d. ZIP:
Daly City
San Mateo County94015BAY AREA AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
07/18/20240800 Residence Human Error
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
NoNoNoReporting Party
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Poison Control
d. ADMIN. AGENCY: San Mateo County 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, CDPH-D.O., Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 24-4113 *********

Created by: Warning Center on: 07/18/2024 01:59:21 PM Last Modified by: Warning Center on: 07/18/2024 02:06:41 PM