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G. MANDATORY San Joaquin Ci Environmental NTACTS Department tit` A (Contact Name) ,,,- /0 V07 14.0 7- 1�,13 (Time) (Date) San Joaquin Count Board of Superviso dl IN N� s: QV?,J / Uv (Contact Name) (Time) (bate) H. HEALTH ANDSAFETY CODE S 25180.7 (b) Any designated government employee who obtains information in the course of his official duties revealing the illegal discharge or threatened illegal discharge of a hazardous waste within the geographical area of his jurisdiction and who know that such discharge or threatened discharge is likely to casue subst tial injury to the public health or safety must, within seventy two hours, disclose such information to the Board of Supervisors and to the local health officer. No disclosure of information is required under this subdivision when otherwise prohibited by law, or when law enforcement personnel have determined that such disclosure would adversely affect an ongoing criminal investigatio, or when the information is already general public knowledge within the locality affected by t e discharge or threatened discharge. (c) Any designated g vernment employee who knowingly and intentionally fails to disclose information required to the disclosed under subdivision (b) shall, upon conviction, be punished by imprisonment in the ounty jail for not more tan one year or by imprisonment in state prison for not more than three years. The court may also impose upon the person a fine of not less than five thousand ($5,000) or more than twenty five thousand dollars ($25,000). The felony conviction for violation of this secti n shall require forfeiture of government employment within thirty days (30) of conviction. I. SIGNATURE D I make this report on behalf of all the designated employees of the County of San Joaquin, and (Agency Name) Signature: Print Name: %ZA r►'r (n.� V�1 Date: lG SITE CODE #: cc:�- Referred To: Title: Time:—Z % (�' ` A.M. / rM) EHD 22-02-003 Notification of Haz Discharge 10/2/2003