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N <br /> 'r <br /> EHD LOG# <br /> G. MANDATORY CONTACTS <br /> San Joaquin County Environmental Health gonna Henan Time: /.I Date: cr- <br /> Department <br /> San Joaquin County Board of Supervisors- <br /> Contact-OMichael Cockrell Time: �{�{ �1 Date: <br /> Office of Emergency Services <br /> H. HEALTH AND SAFETY CODE 25180.7 <br /> (b) Any designated government employee who obtains information in the course of his official duties <br /> revealing the illegal discharge or threatened illegal discharge of a hazardous waste within the <br /> geographical area of his jurisdiction and who knows that such discharge or threatened discharge is <br /> likely to cause substantial injury to the public health or safety must, within seventy-two hours, disclose <br /> such information to the local Board of Supervisors and to the local health officer. No disclosure if <br /> information is required under this subdivision when otherwise prohibited by law, or when law <br /> enforcement personnel have determined that such disclosure would adversely affect an ongoing <br /> criminal investigation, or when the information is already general public knowledge within the locality <br /> affected by the discharge or threatened discharge. <br /> (4) Any designated government employee who knowingly and intentionally fails to disclose information <br /> required to be disclosed under subdivision (b) shall, upon conviction, be punished by imprisonment in <br /> the county jail for not more than one year or by imprisonment in state prison for not more than three <br /> years. The court may also impose upon the person a fine of not less than five thousand dollars <br /> ($5000) or more than twenty-five thousand dollars ($25,000). The felony conviction for violation of this <br /> section shall require forfeiture of government employment within thirty days of conviction. <br /> (. SIGNATURE DISCLOSURE <br /> I make this report on behalf of all designated employees of the County of San Joaquin, and <br /> San Joaquin County Environmental Health Department <br /> (Agency Name) <br /> Signature: <br /> Printed Name: J <br /> Title: �,7 I d c� <br /> J <br /> Date: Time: <br /> M DTSC Site Code: <br /> CVRCVR*WCQCB <br /> t-taFca�cxS Inv' A+1,0 C 1nr�S i 4�r�len YLop,tiiaru er Con MFR Yes No <br /> p(ct F i rn.n x a�crfnn Fru4ch Camp Ctt �SZ31 Referred: <br /> cs„an�r-: jfo&." tans+ Co t.p f=rnt to Cck c13277 <br /> Revised 08/02/12 Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />