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SANJ O A Q U I N Environmental Health Department <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EHD LOG# aO <br /> MANDATORY CONTACTS <br /> San Joaquin County Health Officer- Kasey Foley Time: �j :r�Qm Date: <br /> Care of Environmental Health Departme 1S v_1 a- 'a-Ck 3-() <br /> San Joaquin County Board of Supervisors - Rachel DeBord Time: (g. �p'am Date: <br /> Care of Clerk of the Board <br /> HEALTH AND SAFETY CODE25180.7 <br /> b)Any designated government employee who obtains information in the course of his official duties revealing the illegal <br /> discharge or threatened illegal discharge of a hazardous waste within the geographical area of his jurisdiction and who knows <br /> that such discharge or threatened discharge is likely to cause substantial injury to the public health or safety must, within <br /> seventy-two hours, disclose 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 enforcement personnel have <br /> determined that such disclosure would adversely affect an ongoing criminal investigation, or when the information is already <br /> general public knowledge within the locality affected by the discharge or threatened discharge. <br /> c)Any designated government employee who knowingly and intentionally fails to disclose information required to be disclosed <br /> under subdivision (b) shall, upon conviction, be punished by imprisonment in the county jail for not more than one year or by <br /> imprisonment in state prison for not more than three years. The court may also impose upon the person a fine of not less than <br /> five thousand dollars ($5000) or more than twenty-five thousand dollars ($25,000).The felony conviction for violation of this <br /> SIGNATURE DISCLOSURE <br /> I make this report on behalf of all designated employees of the County of San Joaquin, and the <br /> San Joaquin County Environmental Health Department <br /> Signature: ( i <br /> Printed name: Elianna Florido <br /> Title: REHS <br /> Date: I25 1'-2-0 » Time: 00 P <br /> �eSPonsib(.0- pctrt- pl-opectj Dvj&L, ': <br /> Van 6usCt-f-a of 'Stoc - rl <br /> Mir (�ro ( C� c4tu i L1 S Iv` G 1 D o rz�vCo S . <br /> (005 N L l tIDOrez d 0 � c"rl , � q 520 2 <br /> Cq q Sx 2 <br /> Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />