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7. G. MANDATORY COYI'AOTS Public Health Services of San Joaquin County Environmental Health Division: f� , O Z -�O/1/L� / I�t`Yc� l -�eLg San Joaquin County (Contact Name) �;Q) Board of Supervisors: / 00 ) > It 8a 40 rL. (Contact Mame) (.Lime) H. HEALTH A1ND S (Date) SAFETY CODE 25180.7 b) Any designated government employee who obtains information revealing the illegal discharge or threatened iIleg disharge of a hazardo Soursef hrfficial duties geographical area of his jurisdiction and who bows that such discharge or threatened`disclharge is likely to cause substantial injury to the public health or rmhours safety must. within seventy-two disclose such information to the local Board of Supervisors and m the focal Health v-cwor disclosure of information is required under this subdivision when otherwise prohibited by lav, o� when law enforcement personnel have determined that such disclosure would adversely affect an ongoing criminal investigation, or when the information is al within the locality affected by the discharge or threatened dischargedv general public knowledge C) Any designated government emplovee who knowingly information required to the disclosed under subdivision (b} s all uponanntionalv fails onvicltion, be t�drsclose unprisoament shed by in the county jail for not more than one year or by imprisonment in state prison or not more than three Years. The court may also impose upon the person a fine of not less than five thousand dollars (55,000) or more than twenty-five thousand dollars (525,000). The felonv conviction for violation of this section shall require forfeiture of government emplo4Tnent within thirty days (30)of conviction. I SIGNATURE DISCLOSURE I make this report on behalf of all the designated emplovees of the County of San Jo u- and (Agency-Name) Signature: Typed/Printed Name: Title: S C.o r-rrL CE: Date: Time: SWEEPSNSITE CODE R: // CONiviFR Y/N T mh k- REFERRED TO: l(J — C_ EH 22 013 (Rev. 03/20/98)