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SAN J O A Q U I N Environmental Health Department <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EHD LOG# <br /> MANDATORY CONTACTS <br /> San Joaquin County Health Officer- 041— <br /> Care of Environmental Health Department Wayne Fox Time: \0 � Date: <br /> San Joaquin County Board of Supervisors- <br /> Rachel DeBord Time: �M Date: <br /> Care of Clerk of the Board ��•,2� <br /> HEALTH AND SAFETY CODE 25180.7 <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: <br /> Printed name: Claudia Muro <br /> Title: EH Specialist <br /> Date: G0 7/Off/ �� Time: " �8 x- /'V <br /> —� <br /> Aim —r <br /> CIAL T'IZfaNS <br /> IGoL� SoUTv- {3 s-r�_EE--v- <br /> S-ro c. I C Ar 9 ,5zo6 <br /> AN tD , <br /> 5°I--`ll W �5`t-� bt vtsta �.i <br /> i810 -E - LT0 �,1 AVE , <br /> ,-t o C, k -�o N �. q c 20 5 <br /> Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />