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t <br /> 4 <br /> MANDATORY CONTACTS Lt .. <br /> Public Health,Services <br /> of San Joaquin County ' <br /> Environmental Health Division: /ev l^ �•' J ��"�- / —�r. s �3 <br /> (Contact Name) (Time). (Date) <br /> 1 San Joaquin County /Sc✓Pc�w« j z.21 8 _ <br /> Board of,Supervisors: ; <br /> _ (Contact Name) (Time) (Date) i <br /> H. HEALTH AND SAFETY CODE S 25180.7. <br /> (b) Any designated government employee who obtains information in the course of his official <br /> duties revealing the'Wegal discharge or threatened illegal discharge of a hazardous waste within <br /> the geographical area of'I-ii" jurisdiction and, who knows that such discharge or threatened <br /> discharge is likely to cause substantial injury to the public health or safety must, within seventy- <br /> two hours, disclose such information to the local Board of Supervisors and to the-local health <br /> officer. No disclosure of information is required under this subdivision when otherwise prohibited <br /> by law,or when law enforcement personnel have determined that such'disclosure would adversely <br /> mation is already general public <br /> affect anongoing crutual investi ation or when the -info <br /> knowledge within the 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 <br /> by imprisonment in the county jail for not more than one year or by imprisonment in state prison <br /> for not more than three years: The court may,also impose upon the-person a fine of not less than <br /> five thousand dollars ($5,000) or more than twenty-five thousand dollars ($25,000). The felony <br /> conviction for violation of this section shall require forfeiture of government employment within <br /> thirty days (30) of conviction. <br /> I. SIGNATURE DISCLOSURE -� - - - <br /> I make this rin <br /> eport on behalf of all the designated employees of the County of San Joaqu , and <br /> -- J ou.i 4 4 u ,Z - I k 0t SC'rcJc�Gr <br /> (Agency Name) <br /> -Signature:. <br /> Typed/Printed-Name:- - - - <br /> Title: r SENIOR REGISTERED BVIRQNMENTAL HEALTH,, K AILS T <br /> R' Date: Y -710 Time: � <br /> . .cc: �� S SWEEPS#/SITE CODE#: oaf a P/ C(Ft0 <br /> A <br /> -- .7� ,• CONMFIL Y� N <br /> e <br /> s.. - + :�J�S 5� TG n� • - �.- REFERRED TO- <br /> EH 22 013 (Rev.4/91) <br />