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SAN J O A Q U I N Environmental Health Department <br /> -?U �1,I I <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE / <br /> EHD LOG# 2!2— 0-12 <br /> MANDATORY CONTACTS <br /> San Joaquin County Health Officer- n <br /> Care of Environmental Health Department Jasjit Kan Time.q:22 Date: 1,%%r.L� <br /> San Joaquin County Board of Supervisors- <br /> Care of Clerk of the Board Rachel DeBord Time:a',2 ate: <br /> HEALTH AND SAFETY CODE25180.7 <br /> b)Any designated government employee who obtains information in the course of his official duties revealing the illegal <br /> discharge or threatened illegal discharge of a hazardous waste within the geographical area of his jurisdiction and who knows <br /> that such discharge or threatened discharge is likely to cause substantial injury to the public health or safety must, within <br /> seventy-two hours, disclose 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 enforcement personnel have <br /> determined that such disclosure would adversely affect an ongoing criminal investigation, or when the information is already <br /> general public knowledge within the locality affected by the discharge or threatened discharge. <br /> c)Any designated government employee who knowingly and intentionally fails to disclose information required to be disclosed <br /> under subdivision (b) shall, upon conviction, be punished by imprisonment in the county jail for not more than one year or by <br /> imprisonment in state prison for not more than three years. The court may also impose upon the person a fine of not less than <br /> five thousand dollars ($5000) or more than twenty-five thousand dollars ($25,000).The felony conviction for violation of this <br /> SIGNATURE DISCLOSURE <br /> I make this report on behalf of all designated employees of the County of San Joaquin, and the <br /> San Joaquin County Environmental Health Department <br /> Signature: ;A, -- <br /> Printed name: Kristina Saetern <br /> Title: EH Specialist <br /> Date: ^1/ '1 i 1 ZG2Z Time: , k4 A" <br /> CC, YR C knc_ <br /> i oGq o Roe Avenue <br /> Overkand PUrk , K5 (6(o21 <br /> Jame \Aa7tnes <br /> I I r3 00 'Oat 1100 K- <br /> pve,(kacN\,_ Parte) <br /> Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />