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Signature: <br />Printed nam <br />SANJOAQUIN <br />c 0 L..) 1,1 I Y <br />Environmental Health Department <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EHD LOG # <br />MANDATORY CONTACTS <br />San Joaquin County Health Officer L <br />Care of Environmental Health Depa*ent_v <br />/ <br />Wayne Fox Time: --&• Date: V--) _ <br />San Joaquin County Board of Supervisors - <br />Care of Clerk of the Board Rachel DeBord Time: --7-;.-3L...-,-)\-A--n Date: \-2_71 <br />HEALTH AND SAFETY CODE 25180.7 <br />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 />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 />Title: EH Specialist <br />Date: g277-26-20 <br /> <br />Time: <br />Ito rola) rez <br />1')1,3ox 2Ove <br />rcaio/o, c4526/ <br />Page 2 of 2 <br />1PIRR P I-Im7altnn Axiom IQ I Ctrirletnn ralifrirnia cic9nc I T 9(.1C1 ARR-1d9f) I F 7C1Q L1A4-(11 .-4f1 I tAAAAAI cirphri mm