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Signature: <br />Henry Printed Name: Michelle Hen <br />Title: <br /> Lead Senior Registered Environmental Health Specialist <br />Date: <br /> <br />(40 25- t7 <br /> <br />Time: 5%06'pli <br /> <br />COPY <br /> <br />EHD LOG# <br />MANDATORY CONTACTS <br />San Joaquin County Health Officer— <br />Care of Environmental Health Department Linda Turkatte Time: 9•-.. 'A C? Date: .t?,--ZU 1. <br />Care of Clerk of the Board <br />San Joaquin County Board of Supervisors — <br />Mimi Duzenski Time: a e-, Date: kktAr —I i <br />HEALTH AND SAFETY CODE 25180.7 <br />Any designated government employee who obtains information in the course of his official duties revealing the <br />illegal discharge or threatened illegal discharge of a hazardous waste within the geographical area of his <br />jurisdiction and who knows that such discharge or threatened discharge is likely to cause substantial injury to the <br />public health or safety must, within seventy-two hours, disclose such information to the local Board of Supervisors <br />and to the local health officer. No disclosure if information is required under this subdivision when otherwise <br />prohibited by law, or when law enforcement personnel have determined that such disclosure would adversely <br />affect an ongoing criminal investigation, or when the information is already general public knowledge within the <br />locality affected by the discharge or threatened discharge. <br />Any designated government employee who knowingly and intentionally fails to disclose information required to <br />be disclosed under subdivision (b) shall, upon conviction, be punished by imprisonment in the county jail for not <br />more than one year or by imprisonment in state prison for not more than three years. The court may also impose <br />upon the person a fine of not less than five thousand dollars ($5000) or more than twenty-five thousand dollars <br />($25,000). The felony conviction for violation of this section shall require forfeiture of government employment <br />within thirty days of conviction. <br />SIGNATURE DISCLOSURE <br />I make this report on behalf of all designated employees of the County of San Joaquin, and <br />San Joaquin County Environmental Health Department <br />(Agency Name) <br />c vtPS <br />Pst-khQ 1(k_ 17eng/AA/1i <br />\03 • 4it IN • <br />Wii/tvosp act 'tS3 D <br />Revised 6/01/2015 <br /> Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE