Heat waves and air pollution episodes pose a serious threat to human health and may worsen under future climate change. In this paper, we use 15 years (1999–2013) of commensurately gridded (1° x 1°) surface observations of extended summer (April–September) surface ozone (O3), fine particulate matter (PM2.5), and maximum temperature (TX) over the eastern United States and Canada to construct a climatology of the coincidence, overlap, and lag in space and time of their extremes. Extremes of each quantity are defined climatologically at each grid cell as the 50 d with the highest values in three 5-y windows (∼95th percentile). Any two extremes occur on the same day in the same grid cell more than 50% of the time in the northeastern United States, but on a domain average, co-occurrence is approximately 30%. Although not exactly co-occurring, many of these extremes show connectedness with consistent offsets in space and in time, which often defy traditional mechanistic explanations. All three extremes occur primarily in large-scale, multiday, spatially connected episodes with scales of >1,000 km and clearly coincide with large-scale meteorological features. The largest, longest-lived episodes have the highest incidence of co-occurrence and contain extreme values well above their local 95th percentile threshold, by +7 ppb for O3, +6 µg m−3 for PM2.5, and +1.7 °C for TX. Our results demonstrate the need to evaluate these extremes as synergistic costressors to accurately quantify their impacts on human health.