SITE INFORMATION AND CORRESPONDENCE

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G. MANDATORY CONTACTS• • �� D�O Public Health Services of San Joaquin County N� Environmental Health Division (Contact Name) (Time) (Date) FEB 161999 1 San Joaquin County © Board of Supervisors: — (Contact Name) (Time) (Date) t3 HEALTH AND SAFETY CODE S 25180.7. (b) Any designated government employee who obtains information in the course of his official Q Discharge or threatened illegal discharge of a hazardous waste within duties revealin, the illegal " discharge or threatened the geographical area of his jurisdiction and who knows that such , within seventy- discharge is likely to cause substantial injury to the public health or safety must two hours, disclose such information to the local Board of Supervisors and to the local health equired under this subdivision when otherwise prohibited officer. No disclosure of information is r by law, or when law enforc..ment personnel have det--mined that such disclosure` Dino aad�ve bhc affect an ongoing criminal invstigarion, or when the information is already genera knowledge within he locality affected by the discharge or threatened discharge. (c) Any designated goverment employee who knowingly and intentionally fails to disclose information required to the disclosed under subdivision (b) shall upon conviction be au*ushed county jail for not more than one year or by imprisonment in state prison by imprisonment m the for not more than_three Years. The court may also impose thousand dollars ($25 000). The felony five thousand dollars (55,000) or more than twenty five for violation of this section shall require forfeiture of government employment within thirty days (30) of conviction. I. SIGNATURE DISCLOSURE I make this report on behalf of all the designated employes of the County of San Joaquin and (Agency Name) Signature: Typed/Printed Name: Title: '1'6�cJ i(p 9 Time: �— Dare: cc: G/J Y(� . ✓� SWEEPSr/SITE CODEr: ,U:�' CONMFR Y N R E'r-ERRF7D TO: EH 22 013 (Rev.4/91)