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C. MW NDATOELY CONTACTS Public Health Services of San Joaquin County Environmental Health Division: (TimP) (Date) (Contact Name) � D San Joaquin County „1G�w /— (Date) Board of Supervisors: (Contact Name) H. HEALTH AND Shy CODE S 25180.7. Cb) Any denonated government emplcyee who obtains informano of a hazard course of his Official pus waste within the illegal discharge or threatened Meg' d scharge2, s or threatened duties revealing diction and who knows that such discharge 'thin seventy- the geographical area of his j to the public health or safety must, wl discharge s likely to cause substantial injury aired under this subdivision when otherwise Prohibited two hours, disclose such information to the local Board pi Supervisors and to the local health that such disclosure would adversely off;c�*. No disclosure of information is req �� public bylaw, or when law e�enforcement P�doe have deter is already a invesdga n, or threatened discna oe affect an onwino atiected by the discharge Rnowiedge within the loca"ry who knowingly and intentionally fad to disclose Any designated gove'nxaent employe_ shaILanon coavicdon, be Punished (c) risonment is state Prison information requir✓d to he d� e i under mora than oneyearor by imp by tmprssomnent .a�<�ars. jail court may also impose upon the pe*spa a fine of not less than Eve thousand dollars (525,000)• The felony for not more than three Y Qovemenc employment wig five housand dollars CS5,000) or mare than for°eiture of o conviction for violation of this section shall req uire thirty days (30) of conviction. I, SIGNATURE DISCLOSURE ted employees of the County of San Joaquin, and I make this report on behalf of all 'he designs (Agency Name) gnature, STyped/Printed Nam Date: "7 PA -0.-r—S- C. SWEEPV SITE CODE#: CC' CONDCR Y/ N EH 22 013 CReV-4/91)