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EHD LOG# <br /> G. MANDATORY CONTACTS 2J� <br /> San Joaquin County Public Health Services- Donna Heran Time: !7 Date: q <br /> Contact-Environmental Health Department <br /> San Joaquin County Board of Supervisors- Michael Cockrell Time: q v(17� Date: I-/7-(Z <br /> Contact-Office of Emergency 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: Aris Cacapit <br /> Title: Registered Environmental Health Specialist <br /> Date: —t2 Time: <br /> cc: DTSC Site Code: <br /> CVRWQCB <br /> 414o' <br /> n4' 4.�n✓s � Con MFR Yes No <br /> Y �T1T>+'' f7 T/' Referred: <br /> Revised 04/19/12 Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />