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off` _MANDATORY CONTACTS 'San`Ioaquiii County a - - - � �Envirorizneltal Health Department. 3 !•� _ (Contacx�le) (Time) (Dae) ,. San Joaquin County Board of Supervisors: / / (Contact Name) (Time) (Bate) 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 know that such discharge or threatened discharge is likely to Cause substantial injury to the public health or safety must,withirt seventy two hours, disclose such information to the Board of Supervisors and to the'local health officer. No disclosure of information is required cinder this subdivision when otherwise prohibited by law, or when law enforcement personnel have determined that such disclosure would adversely affect an ongoing .:i criminal investigation, or when the information is already general public knowledge within the locality affected by the discharge or threatened discharge. (c) Any-designated government employee who knowingly and intentionally fails to disclose informationi"to the disclosed under subdivision(b)shall,upon conviction,be punished by imprisonment in the county jail for not more tan one,yeak or by imprisonment in state prison for not more than three years. The court may also impose upon the person a-fine df not less than five thousand(55,000)or more than twenty five thousand dollars($25,040). The felony conviction for violation of this section shall require forfeiture of government employment within thirty days(30)of x Conviction. k_) I. SIGNATURE DISCLOSURE a i make thisort on behalf of all the designated employees of the County of Joaquin and ' V r ( Name) . Signature: u Print Name: Title: Date. Time: p " SITE, CODE#: CC: 4 Referred To: w END 22-03 Notification of Haz Dischuge iil�62007 '