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SAN JOAQUIN couNiy <br />Environmental Health Department <br />NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br />EHD LOG # \V3 <br />MANDATORY CONTACTS <br />San Joaquin County Health Officer - <br />Care of Environmental Health Department <br />/r <br />Jasjit Kang i <br />\ <br />Time: \10,crcy-) <br />.. <br />Date: \1/4:\A‘ <br />San Joaquin County Board of Supervisors - <br />Care of Clerk of the Board Rachel DeBord Time: \ ', C) vv\ Date: \O\ \0\,2{2._ <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 J aquin County Environmental Health Department <br />Signature: <br />Printed name: Paul Nso <br />Title: EH Specialist <br />Date: to L.) Time: t <br />C C C etA \Nrc \ V c1/4 ( L's) t- n c_e <br />AACT: Eizt c,„,‘L <br />333 e 1-(AyeAe,sc g-P <br />Lo c g s-2(4 <br />Gcvv-cQvve-r,. <br />t1(91 edy&E,JDod <br />Lodi coot 959-40 <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 <br />cc