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LF <br /> EHD LOG# <br /> G. MANDATORY CONTACTS <br /> San Joaquin County Environmental Health Donna Heran Time: Date: <br /> Department :�-Z <br /> San Joaquin County Board of Supervisors— Michael Cockrell Time: Date: b j <br /> Contact—Office ofEmergency Services <br /> H. HEALTH AND SAFETY CODE 25180.7 <br /> (b) Any designated government employee who obtains information in the course of his official duties <br /> revealing the illegal discharge or threatened illegal discharge of a hazardous waste within the <br /> geographical area of his jurisdiction and who knows that such discharge or threatened discharge is <br /> likely to cause substantial injury to the public health or safety must,within seventy-two hours, disclose <br /> 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 <br /> enforcement personnel have determined that such disclosure would adversely affect an ongoing <br /> criminal investigation, or when the information is already general public knowledge within the locality <br /> affected by the discharge or threatened discharge. <br /> (c) Any designated government employee who knowingly and intentionally fails to disclose information <br /> required to be disclosed under subdivision (b)shall, upon conviction, be punished by imprisonment in <br /> the county jail for not more than one year or by imprisonment in state prison for not more than three <br /> years. The court may also impose upon the person a fine of not less than five thousand dollars <br /> ($5000)or more than twenty-five thousand dollars($25,000). The felony conviction for violation of this <br /> section shall require forfeiture of government employment within thirty days of conviction. <br /> I. 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 /> Signature: <br /> Printed Name: <br /> Title: <br /> Date: <br /> Time: 9. t�Y'v <br /> � L <br /> cc: DTSC Site Code: <br /> CVRWQCB <br /> !7G5�lnc,a��► rc�hG�r� AttN Clvr_�a1 S)ngh C��)) Con MFR Yes No <br /> � Referred: <br /> �b 3c>x a I Tract] CQ q537(- <br /> ad R�f t-j) AttA.i = ►ed a_.InsiDn zs-i t j )Ina Ade 'P_Ifrn 9 5 bc-b <br /> vonor' Q,1 a-t- ;mod Cwibib CLC- P,, W--y 5 V76 i eklit9b? k-1/ (f6� S� <br /> Revised 08/02/12 Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />