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SANJ O A Q U I N Environmental Health Department <br /> U -AIY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EHD LOG# <br /> MANDATORY CONTACTS <br /> San Joaquin County Health Officer- Q <br /> Care of Environmental Health Departmen Kasey Foley Time: 3; ti.�pm Date: / 2- / _ _/ <br /> San Joaquin County Board of Supervisors- <br /> Care of Clerk of the Board Rachel DeBord Time: 3; �(pPm Date: <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: <br /> Printed nam . Jasonitan <br /> Title: E1ii�H Specialist' <br /> Date: -11—1stTime: J LIUQ�n <br /> C� C hC+r K1,V? 1 X514)0 IYAR-TSVA <br /> f 1130 UJ -1"C7E/i /t'li�E f?o. <br /> 4du6 <br /> SICK%oil, CA �5.2G�/ SiGLk i U�� CA G52 ►G <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 />