copy of judgment must be attached ( )4.1 civil penalty payment pursuant to health & safety code...
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State of California - Department of Justice - Attorney General’s Office - Proposition 65 Enforcement ReportingAttention: Prop 65 Coordinator, 1515 Clay Street, Suite 2000, Oakland, CA 94612
PRIVATE ENFORCEMENT FILING - Health and Safety Code section 25249.7(e) and (f)
REPORT OF ENTRY OF JUDGMENT
FORM JUS 1502(03-01)
For
Inte
rnal
Use
Onl
y
❒ Original Filing ❒ Supplemental Filing ❒ Corrected FilingPlease print or type required information
AC
TIO
N T
HE
OT
TIE
S
RAP
PLAINTIFF(S)
DEFENDANT(S) INVOLVED IN JUDGMENT
CA
SE
INF
O
COURT DOCKET NUMBER COURT NAME
SHORT CASE NAME
INJUNCTIVE RELIEF
RE
PO
RT
IN
FO PAYMENT: CIVIL PENALTY PAYMENT: ATTORNEYS FEES PAYMENT: OTHER
DATE SUBMITTED TO COURT
/ /
IS JUDGMENT PURSUANTTO SETTLEMENT?
❒ Yes ❒ No
IF YES, DATE SETTLEMENT WASREPORTED TO ATTORNEY GENERAL
/ /
COPY OF JUDGMENT MUST BE ATTACHED
FIL
ER
INF
O
NAME OF CONTACT
ORGANIZATION TELEPHONE NUMBER
( )ADDRESS FAX NUMBER
( )CITY STATE ZIP E-MAIL ADDRESS
FILING INSTRUCTIONS: This form can be completed online and printed. If electronic filing is not available, mail the completedform with a copy of the judgment to the attention of the Prop 65 Coordinator at the address shown above. If you need additionalspace to complete this form please use an attachment.
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