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I , 102-D7 6r 0-44 1:"C <br />Sigriature: <br />Tyoed/Printed arae: <br />Title: S r <br />Date: y Time: <br />CX•it SWEEPS-#/5172 CODE#: 3i3 ö <br />CO <br />REFERRED TO: <br />cc: <br />EH 22 013 (7...ev.4/91) <br />(4 1- iz9‘u <br />G. MANDATORY CONTACTS <br />Public Health services <br />of San Joaquin County <br />Enviromental Health Division: 141 n 6-2-- (Dare) (Contac-t Name) (Time) <br />1 San Joaquin County- 1) <br />Board of Supervisors: <br /> <br />CTLT-e) (Date) (Contact Name) <br />HEALTH AND SAFETY CODE S 25180.7. Co) Any desigiated government employee who obrAirtl informarlon in the course of his official <br />dues revealing the dleg-ai disr4-tntgP or threatened illegal discharge of a hazardous waste wirhir <br />the geographical area of his jurisdiction and who 'mows that such disrhrge or threatened <br />discharge is likely to cause substantial injury to the public 11th or safety must, within seventy- <br />two hours, disclose such information to the local Board. of Supervisors and to the local health <br />officer. No disclosure of information is required under this subdivision when otherwise prohibited <br />by law, or when law enforcement personnel have determined that such disclosure would adversely <br />affect an ongoing a•;Trirnl investigation, or when the information is already general public <br />knowledge within the locality affected by the discharge or threatP,1,-4 disc4large. <br />(c) Any desip.ated government employee who knowingly and intort.lny fans to disclose <br />infcrinancn required to the disclosed under subdivision Co) sl,nn, upon. conviction, be punished <br />by imprisonment in the county jail for not more than one year or by imprisonment in. state prison <br />for not more than three years. The court may also impose upon the person a fine of not less thar- <br />Eve thousand dollars ($5,000) or more rhPr twenty-Eve thousand dollars ($25,000). The felony <br />conviction for violation of this secdon shall require forfeiture of gove--mmt-,-it employment within <br />thirty days (30) of conviction. <br />SIGNATURE DISCLOSURE <br />I make this report on bf=4,PIf of all the desipated employees of the County of San Joaquin, and <br />(Agency Name)