To reduce CO2 emissions of a conventional diesel engine garbage truck, we developed an electric motor driven fuel cell garbage truck. It was designed based on analytical result of two garbage collection routes, Kanmon-route and Imajuku-minami route of Shunan City of Yamaguchi Prefecture, Japan. It was trial produced to satisfy the same driving performance as a conventional diesel engine garbage truck. A chassis dynamo test was performed to compare the vehicle component energy consumption with a conventional diesel engine garbage truck during two driving scenarios, general driving (Tokyo No. 8 mode) and garbage collection driving (Tokyo garbage collection mode). From the chassis dynamo test, the energy consumption reduction rates when the diesel vehicle was replaced by the fuel cell vehicle were 69% in the Tokyo No. 8 mode and 81% in the Tokyo garbage collection mode. The CO2 emissions reduction effect was calculated using correction to the energy consumption of the general route in Shunan City based on the chassis dynamo test results. In case of using energy consumption correction based on the total travel distance and the weight of garbage, we estimated that the improvement of the fuel efficiency was between 1.6 to 1.8 times in terms of CO2 emissions. For further improvement to reduce energy consumption of a fuel cell garbage truck, three measures (vehicle weight, PTO gear ratio and regeneration energy) were considered by the vehicle simulation.