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V�L <br /> 1 MANDATORY CONTACTS <br /> San Joaquin County // ti . ZO , / q 1.2c g) <br /> ' Local Health District: v Date <br /> ontact Name <br /> San Joaquin County D —J--� �_ <br /> Board of Supervisors: �� Co tact Name ate <br /> H. HEALTH AND SAFETY CODE 4 25180.7. <br /> ) ndesignated government <br /> iteveinthinformation <br /> oin the <br /> co -seof hisofficialdtesrevalg e illegal or <br /> threatened illegal discharge or threatened illegal discharge of a <br /> hazardous waste within the geographical area of his Jurisdiction and who <br /> knows that such discharge or threatened discharge is likely to cause <br /> substantial injury to the public health or safety must, within <br /> seventy-two hours, disclose such Information to the local Board of <br /> Supervisors and to the local health officer. No disclosure of <br /> information is required under this subdivision when othb prise prohibited <br /> by law, or when law.enforcement personnel have determined that such <br /> disclosure would adversely affectan <br /> ongoing <br /> publicriminaldinvestiga ationthe, or <br /> when the information is already general <br /> locality affected by the discharge or threatened discharge. <br /> (c) Any designated government employee who knowingly and intentionally <br /> fails to disclose information required to be disclosed ugder subdivision <br /> jails <br /> forinot more than tone�year poriby imprisonment ninnstate t In tcountyhe <br /> be prison for I <br /> not finemof not less than five thousandars. The rdollarslso($5�000)eor�morehthanrson a <br /> twenty-five thousand dollars ($25,000). The felony conviction for <br /> violation of this section shall require forfeiture of government <br /> employment within thirty days of conviction. <br /> I. SIGNATURE DISCLOSURE <br /> I make this report on behalf of all the designated employees of the <br /> County of San J)D Tu <br /> uin, and the San Joaquin County Local Health District, <br /> and /�.D./�.5. SC./� <br /> Agency Name <br /> Signature: <br /> Typed Name: <br /> Title: <br /> D te: Time: <br /> e Revised 3- 18-81 <br />