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e <br />SAN,,JOAQUIN <br /> Environmental Health Department <br />COUNTY— <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EHD LOG # <br />MANDATORY CONTACTS CONTACTS <br />San Joaquin County Health Officer - 0 <br />Care of Environmental Health DepartL/ <br />. <br />e <br />I <br />Jasjit Kang Time: \\ :50 cmr, Date: \\ \ \D V2...._\ <br />San Joaquin County Board of Supervisors - <br />Care of Clerk of the Board Rachel DeBord Time:\\. be own Date: 1\\ \t) V2, \ <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 />Signature: <br />Printed name: Frederick Ernest <br />Title: RENS <br />Date: II/10/2c2-1 Time: g 10 #111 <br />ceerl-ral vrtlicy Guckcf-e_ 4-Itic,5 64.6.4- <br />e 0 g c..)e 29104., <br />1'41 (Ai 415791 <br />(ocAs+ Prc ,..)kce,i5 <br />5c) 5 &old' i9ve , <br />Lbei t (et %vie) <br />Page 2 of 2 <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sjgov.org/EHD