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MANDAfIQI Y CONTACTS <br /> San Joa um tiunty <br /> Envlronmentarl Health Department: Do"" (-!' 2 +* <br /> r ^ 1 ! //.'30,pq ! /o bfi <br /> (Contact Name) (Time) (Date) <br /> San Joaquin County <br /> Board of Supervisors: N 8,tHlNfo✓ ! A56mn ! 1101V161Rn" <br /> (Contact Name) (Time) (Date) <br /> eD SAFETY CODES 25180.7 <br /> Any�e,,s.lgnated government employee who obtains information in the course of his official duties <br /> u `revea"ling"[hk illegal discharge or threatened illegal discharge of a hazardous waste within the <br /> geographical area of his jurisdiction and who know that such discharge or threatened discharge is <br /> likely to casue substantial injury to the public health or safety must,within seventy two hours, <br /> disclose such information to the Board of Supervisors and to the local health officer. No disclosure <br /> of 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 <br /> locality affected by the discharge or threatened discharge. <br /> (c)Any designated government employee who knowingly and intentionally fails to disclose <br /> information required to the disclosed under subdivision (b)shall,upon conviction,be punished by <br /> imprisonment in the county jail for not more tan one year or by imprisonment in state prison for not <br /> more than three years. The court may also impose upon the person a fine of not less than five <br /> thousand($5,000)or more than twenty five thousand dollars($25,000). The felony conviction for <br /> violation of this section shall require forfeiture of government employment within thirty days(30)of <br /> conviction. <br /> I. SIGNATURE DISCLOSURE <br /> I make this report on behalf of all the designated employees of the County of San Joaquin, and <br /> (Agency Name) <br /> Signature: � — <br /> Print Name: 24i rj µrl� U�/J �l Title: SP, 2 N S <br /> Date: 10 �I 0:72 Time: I t':C36 �*� P•M <br /> SITE CODE #• <br /> cc: D T S'c <br /> C l) 2 VV 4 C, NON -r-111V,) <br /> C t yu M 8 <br /> E, --F <br /> . p�ullG wor1�1 - -b tp 1M96� <br /> Referred To: <br /> END 22-02.003 Notification of Hac Discharge <br /> 10/2/2003 <br />