Abstract: On March 5, 2013, an employee reported to the regular garbage pick-up route after a three day weekend, and a Friday down day for the trucks to be serviced. Garbage bins and can loads at the 37 pick-up sites were high and hands loading from spills outside containers were described as above average. A coworker, who was assisting for the higher than normal loads for this day only, did not observe anything wrong from the employee. The employee had swollen hands and ankles driving home from work, but did not think anything of it. By 8:30 p.m. on March 5, 2014, the employee had broken out with rashes on his arms, legs, neck, scalp and hands. By 11:30 p.m. the swelling was bad enough to go to the emergency room of Kaiser, Manteca, CA, which said it might be work related. Medications were provided, and the swelling and rash subsided within hours. The employee returned home, broke out worse at home, and then came back to the same Kaiser the following morning. The employee was kept in the hospital for three days, under observation and given various medications for swelling, allergic reactions and systemic controls. He was released and had subsiding symptoms throughout the seven days following. The employee knows of no food, allergens or chemicals that cause allergic reactions to him. The route had no unusual variables, except the heavy loads. The employee did get some oil on the forearms from the truck air brakes compressor tank, but these waste compressor fluids have not caused a reaction prior to this day. The causative agent was unknown.