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J 'V G. MANDATORY CONTACTS Public Health Saviccs of San Joaquin County (0 , cj 0 JX4 Environmental Health Division. (Contact Name) (Titan) (Date) San Joaquin Counry �� ..1i Board of Supervisors- (Caatact Name) (Time) (Date) H. HEALTH AND SAFETY CODE S 25180.7. (b) Any designated government employer who obtains information is the course of his official the r�lecal discharge or threatened Meo A dischazge of a hazardous waste within duties revealing d or threatened rhe geographical area of his Ju= coon and who lmcws that such discharge discharge is likely to cause substantial in}ury to the public health or safety must, within seventy- two hours, disclose such information to the local Board of Supervisor and to the local health hi officer. No disclosure of information is rewired cinder such �osion when e' d adversely by law, or when law enforcement personae.have der �e,� public investigation, or when. the information is already a affect an on, affected b arQe- l{nowiedge within the locality y the discharge or threarened disch (c) Any designated government employee who knowingly and intE=on�y �s to disclose uid to rhe disclosed under subdivision (b) sbaII, upon conviction, be punished =ornation req, risonmerzt in state prison by imprisonment is the counry jail for not more than one year or by imp years. The court may also impose upon the person a fine of not less than for not more than du-L--five thousand doltars CS5,000) or more than twtnrY-five nc�usaad dollars (S25,000). The felony` conviction for violation of this section shall require forte=turn of gove*-sarent employment within thiry days (30) of conviction. I, SiCNATURE D4SCLOSURE I make this report oa behalf of aII rhe des`gnated employees of the County of San Joaquin, and C��Y Nie) Signature: Typed/Printed Name: Title: S Time; I Pin Date: SrATEPS#/SITE CODE#: cc: CONMFR Y/ N REFERRED TO: R EH 22 013 (Rev.4/91)