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v� <br /> OFZY CONTACTS <br /> G. MANDAT <br /> 'c Health,ServicesT� � - _� � / <br /> �f San Joaqun County - GJ (Date) <br /> ° Division:En�nmental Health (Contact Name) <br /> San-Joaquin County <br /> San (T'uae) <br /> . Board of Supervisors: (Coact Name) <br /> CoE S:25180.7._ = � In � �aurse of his offiCial <br /> � <br /> informer on to thin <br /> H. �HEALTH Al`ID S v �t e�aploye who ab disc °f a a neatened <br /> such dischae , <br /> An designate �� ��ge or threat� knows that - win seventy- <br />. ���� y <br /> r duties reVe I area. of his }urisdiction-and public heap or safery,m <br /> usrl the geograil to the p <br /> • el to cause substantial ink• Deal.Board,of.Superman.and to se P hibited { <br /> discharge y ormation.to the l �bdivision when oth <br /> two hours,-disclose,such inf under this that such would adversely <br /> On No disclosure of�ormauon is requireda determined disrdosure Public <br /> =meta personnel fotion is already g�e'alb:P <br /> by law, or when law=-fore mvesdganon,.or..when the leered. e'R <br /> +.affect an ongoing : erected by the discharge.or,threa ' clo <br /> Wiminal <br /> 1 <br /> the l :w `. •off '�s to <br /> 'disclose <br /> led e Y <br /> know g �. .� ....... and Ftenn. <br /> who;knowingly .n_ mon,, be punished <br /> government <br /> -employee shall, r_onvi state rison <br /> ... ..�.(c) Any,desipated go anon <br /> to the disclosed uncle: subdivision @) or by�prisonme��• P <br /> • ortnarion regw1ed for not more than one year.. e1son a flue of not less thzar <br /> mf a upon the P felony <br /> crimen in the county 1� �y.aiso impos� ' 1QE}0). ,The <br /> . by imp �;.The court - d dollars ($25 . <br /> for ynot more than three Y twenty-five thous�n r employment wig <br /> _x Ve thousand dollars�(SS;000)..or mon shall require forfeiture of govexnm <br /> fi f thus sectio —r, for a • ' r , <br /> .- convicndaoys (30} of.convicrion.. - <br /> _,thirty - <br /> I, SIGNATURE D[SCLOSURE F . '. - 'of San.T1 �d <br /> -�Te�ioye�oaf'theCountyy� - . , .o <br /> ., <br /> 1.make,this.report on behalf of all the designer - µ <br /> t <br /> Nazne) <br /> Signature: >e, <br /> -- TypTitle: to h T'uae: <br /> .Date. - <br /> �' 5-w PL '10 . <br /> CODE : 'g 3 l . <br /> -cc.. <br /> x.....,w4 ..-. a n R Rw.�.p...- .+b .- .a r .-•.•...y. A' e�i' .�.a+-1 + ��+` _ a..r+' —..- r <br /> EH 22 013 (Rev.4/91) <br />