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G "MAiORY CONiACiS Sdn Joaquin County Local Health District: Contact Namc Time Date San Joaquin County Board of Supervisors: Contact Name Time Date H• HEALTH AND SAFETY CODE 4 25180.7. (b) Any designated government co -Se of his official employee who obtains info threatened illegal duties revealing the illegal dfschartion in the hazardous Waste within discharge or threatened illegal discha 9e or M thin the geographical area of his Jurisdictf naand who - knows that such discharge or threatened discharge substantial in,Jury to the public health or seventy-two hours, disclose such info is likely to cause safety must, within Supervisors and to the local health tion to the local information is re ui officer. No disci su Board of by law, V rdd under this subdivision O re °f or when law enforcement personnel have determined thsat such disclosure would adversely Prohibited when the info affect an ongoing criminal investigation. or locality affectation Is aladygeneral public knowledge within the. discharge or threatened discharge. (c) Any designated government em onally fails to disclose Information employee who knowingly and in falls shall , upon conviction required to be disclosed under Lsubiivisio jail for no[ be Punished by imprisonment in the ucounty ton not more snore than one year or by imprisonment in state prison for re than three years. The court may also impose flee of not less than five thousand dollars fine O fiot thousand dollars 0upon the person a violation of (525,000 , X55.000) or more than this section shall ) The felony conviction for employment within thirtyrequire forfeiture of ova days of conviction, government I - SIGNATURE DISCLOSURE I make this report on behalf of all the designated employees of the County of San Joaquin• and the San Joaquin Count and q Y Local Health District, Agency Name ° Y Signature: I SCS Typed Name: Cv (ZwgL�y Title: Date: Time: Revised 11-87