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EHD LOG# 1Q G. MANDATORY CONTACTS San Joaquin County Environmental Health Donna Heran Time: , Date: _�� Department San Joaquin County Board of Supervisors— Michael Cockrell Time: l/' Date: Contact—Offioe of Em n Services H. HEALTH AND SAFETY CODE 25180.7 (b) Any designated government employee who obtains Information in the course of his official duties revealing the illegal discharge or threatened illegal discharge of a hazardous waste within the geographical area of his jurisdiction and who knows that such discharge or threatened discharge is likely to cause substantial injury to the public health or safety must,within seventy-two hours,disclose such information to the local Hoard of Supervisors and to the local health officer. No disclosure if information is required under this subdivision when otherwise prohibited by law, or when law enforcement personnel have determined that such disclosure would adversely affect an ongoing criminal investigation,or when the information is already general public knowledge within the locality affected by the discharge or threatened discharge. (c) Any designated government employee who knowingly and intentionally fails to disclose information required to be disclosed under subdivision(b) shall, upon conviction, be punished by imprisonment in the county jail for not more than one year or by imprisonment in state prison for not more than three years. The court may also impose upon the person a fine of not less than five thousand dollars ($5000)or more than twenty-five thousand dollars($25,000). The felony conviction for violation of this section shall require forfeiture of government employment within thirty days of conviction. I. SIGNATURE DISCLOSURE I make this report on behalf of all designated employees of the County of San Joaquin, and San Joaquin County Environmental Health Department ftwi y Nemo} Signature: Printed Name: Title: Date: Time: cc: DTSC Site Code: CVRVVQC13 (I of 5+0(x wn} ` cily hurvT Con MFR Yes No r_^`Me'Ooh. 00b . �n��f Referred: Pp �` 17 S5 b r F,resna, al 4 Toil 5. cst A-t/'C, ff'PS►'�8�1r� Revised 08102112 Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE