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ti G. MANDATORY CONTA 15 Public Health Services of San'Joaquin County .. `.6- Environimntal Health Division: We. /P��l I/ i✓o Ti' ( •��' / r _ - (Contact Name) (Time) (Date) 1 San.Joaquin County- Board of Supervisors: _ ./t/G� ci.✓ �/ Y. . k (Contact Name) (Time) (Date) H. - ,HEALTH AND SAFETY CODE S 25180.7. (b), Any designated government employee who obtains information in the course of his official _ —duties revealing the illegal discharge or threatened illegal discharge of a hazardous waste within ._the .geographical area of his jurisdiction and who knows that such discharge or threatened 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,and to the local health officer. No disclosure of information is required under this subdivision when otherwise prolubited by law, or when law enforcement personnel have determined that such disclosure would adversely affect an ongoing criminal investigation, or when the information is already general public knowledge.within the locality affected by the discharge or threatened'discharge. .r (c) Any designated government employee who knowingly and intentionally fails to disclose information required to the disclosed;under subdivision (b) shall, upon conviction, be punished by imprisonment in the countyjail for not more than one year or by imprisonment in state prison for not more than three years. The court may`also impose upon the person a fine of not less than . five thousand dollars ($5,000) or more thari twenty-five thousand dollars ($25,000). The felony conviction for violation of this section shall require forfeiture of government employment within thirty days (30) of conviction, I. . SIGNATURE DISCLOSURE - 4 Imake this report on behalf of all the designated employees of the County of San Joaquin, and (Agency Name) Signature: Typed/Printed Name: /tliC�iS¢L� - iN URW,+ bT" Title: R S Date: Time: 4 d CJ�,z cc:� [ ".2£t SWEEPS##/SITE CODE+/: tiM1 CONMFR 0 N S - REFERRED TO• EH 22 013 (Rev.4/91)