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EHD LOG# ILl -fJ <br /> G. MANDATORY CONTACTS <br /> San Joaquin County Environmental Health Donna Heran Time: <br /> Department <br /> San Joaquin County Board of Supervisors— Michael Cockrell Time: Date: <br /> Contact—Office of Emergency Services fl•77 d y <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: 'irr/� �i�/�L/ J-� — <br /> Printed Name: Al&Lel /7'?nr/r/7ovr <br /> Title: 1iABty,il� Gm/ors <br /> Date: //a✓,% �U zany Time: 9-•Z0 <br /> T i <br /> cc: DTSC /� ✓' m f r lee' Site Code: <br /> CVRWaCB,A4+11' Oar)CA4✓ A44 S" <br /> i <br /> y,' �0-( A6 n{p-ccs � <br /> A ':GJ-c� Mana�,�- Con MFR Yes No <br /> f^ 7 Referred: <br /> barl G TD fc D� -nc Eve Qu/l�1 <br /> fige a, q.-P_ D, WYfon, U7 <br /> ppQP,r1 t n Vda*g4;ne- PrOO? t esu Alter• 1 im0*1 Vctffm+Me� <br /> ou✓n aSI W- Sfl /Pb'nff",'A <br /> Revised 08/02/12 Page 2 of 2 NOTIFICATION OF HAZ WASTE DISCHARGE <br />