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- Environmental Health Department <br /> SAN <br /> _ JOAQUIN 1__1 ._] I ./ <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> EHD LOG# �2D-/03 <br /> MANDATORY CONTACTS <br /> San Joaquin County Health Officer- �\ Wayne Fox Time: Date: <br /> Care of Environmental Health Department a . �-o <br /> San Joaquin County Board of Supervisors- <br /> Care of Clerk of the Board Rachel DeBord Time: 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 Joaq County Environmental Health Department <br /> Signature: <br /> Printed na Zas( n an <br /> Title: EH Specialist 1' 36/ <br /> Date: B- -26�20�1 Time: 1' 36 rig <br /> S i S �o ,(4,,cs ink <br /> 5 <br /> Dep�. or I��bI►C !,(�o��cs 3��� %wns�►en� C•r�le <br /> I IC) /��>✓I�'o(t Ave <br /> StC( Lto/k , CA <br /> 56L-6v/ CA �52Us <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 />