SITE INFORMATION AND CORRESPONDENCE

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G. MANDATORY CONI'ACO '•��'"-'�"x ., Public Health Services � of San Joaquin County .., ' t' fo. Environmental Health Division: ��l�� E ✓ ! // �D U / Date) (Contact Name) (Time) 1 San Joaquin County �/� / // �.7 o Board of Supervisors: ON (Time) (Date) (Contact Name) H HEALTH AND SAFETY CODE S 25180.7. urse (b) Any designated n in the co government employee who obtains informati e of a hazardous owaste within duties revealing the illegal discharge or threatened illegal discharg 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- two hours, disclose such information to the local Board of Supervisors when otherwise prohibited officer. No disclosure of information is required under th this subdivision b law, or when law enforcement personnel have determined that no disclosure is °enadversely y or when the informs affect an ongoing criminal investigation, e or threatened discharge. knowledgewithin the locality affected by the discharg 1 and intentionallyfails to disclose (c) Any designated government employee who knowingly i on conviction, be punished information required to the disclosed under subdivision (b) shah, P risonment , state prison by imprisonment in the county jail for not more than one year or by imp impose upon the person a fine of not less than for not more than:three years.: The court may also fiP e thousand dollars ($25,000). The felony five thousand dollars (55,000) or more than twenty- to ent within conviction for violation of this section shall require forfeiture of government emp ym thirty days (30) of conviction. I. SIGNATURE DISCLOSURE I make this report on behalf of all the designated employees of the County of San Joaquin, and (Agency Name) Signature: Typed/Printed N a_rne: Title: Time: /offs Date: i SWEEP SI/SITE CODE:, I CONNIFR Y REFERRED TO: EH 22 013 (Rev-4/91)