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G MANDATORY CONTACTS Public Health Savices 0 W/ —q� of San Joaquin County yua pmtal Health Division: (Z SSP) (Date) (Contact Name} San Joagi yn CotY �.�,lc�. ►�•S ) Cpate) Board of Supervisors- (Contact Name} H. HEALTH AND SAFETY CODE S 25180.7. ju the course designated gove-nUne"t employees who obrains informationaro f a hazardous Of his official within @) Any or threatened iilea�l discharge duties revealing the illegal discharge or threatened the geographical area of his jurisdiction and who knows that such discharge discharge is likely to cause substantial injury to the public health or safety must, within seventy- o hours, disclose such infcrmarith on to the local Board of�S�p�w� to otherwise prohibited the local � d under flus subdivision disclosure officer. No disclosure of information is require b law, or when law enforcement pey*sonnel have determined that s�atiou is acedy Q�� public y criminal investigation, or when the affect an ongoing affected by the discharge or threatened dischars- knowledge within the locality . who knowingly and iutmdonaily fails to disclose {c) Any designated gove�unent employer s upon canvicdon, be punished information required to the disclosed under subdi`riszati �°ar or by imprisonment is state prison '~ by imprisonment in the county jail for not more than one ye The court may also impose upon the person a fine of not less th.ar`, for not more than three Yew• five thousand dollars (S 00()). The felony five thousand dollars (;5,000) or more than twenty- vernment employment within conviction for violation of this section shall require forfeiture of go arty days (30) of conviction. 1. SIGNATURE DISCLOSURE r make this repot an behalf of all the designated employees of the Counry of San Joaquin, and (Agency Name) Signature: Typed/Printed Name: Title: S Tune: Date: SWEEPSjt/SITE CODE#: cc: CONU FR Y/ N tom. REFERRED TO: SH 22 013 (Rev-4/91)