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Signature: <br />Printed name: abriela Garcia-Mejia <br />Title: EH Specialist <br />SAN JOAQUIN <br /> Environmental Health Department <br />COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EHD LOG # -610 <br />MANDATORY CONTACTS <br />San Joaquin County Health Officer - <br />Care of Environmental Health Department 84-"Jasjit Karig Time: , , evp ni Date: 1_17 _wo <br />San Joaquin County Board of Supervisors - <br />Care of Clerk of the Board Rachel DeBord Time: -3 ' -. Zopir Date: <br />I -I 7- Z003 <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 />Date: <br />14..5100/1/a e. <br />PO c* 993,20 <br />.Astoine0/2 to2 9V . 99 <br />Time: fit" <br />pfoyeifr efrap. <br />v orA "ode ) Croe 6 4' Ei,zttba <br />ro eoK 224% <br />Z-vd:i 2 61C/524 / <br />Page 2 of 2 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD