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1 <br /> N <br /> EHD LOG# <br /> G. MANDATORY CONTACTS <br /> San Joaquin County Public HealthServices <br /> Contact - Environmental Health De= Donna Heron Time: (Date: 1� 1?j <br /> San Joaquin County Board of Supervisors – Ran Baldwin Time: + 1' Date: j <br /> Contact – Office of Emergengy Services _ ✓� ,7 <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,o when the information is already general public knowledge within the locality <br /> affected by the discharge or threatened discharge. <br /> (c) Any designated government employee who knowingly and Intentionally fails to disclose information <br /> required lobe 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 /> I. 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: )M i NVIA A Cm— <br /> Printed Name: (,v (LI 1> 0iuC4AJ <br /> Title: est 9 E jacF <br /> Date: 13 I I Time: 7, : 2, 6 Pn4 <br /> �I <br /> cc: DTSC Site Code: <br /> CVRWQCB ler <br /> G ') 4 � � y 7 __, Con MFR Yes No <br /> ,I--"t �S Referred: <br /> CDM <br /> o a w we !�; iAve 4b75 <br /> NOTIFICATION OF HAZ WASTE DISCHARGE Page 2 of 2 Revised 10122/10 <br />