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C -aO L� G. MANDATORY CONTACTS Public Health Services of San Joaquin County ' EnvironmentalI-IealthDivision: 10 San Joaquin County (Contact Name) (Time) (Date) Board of Supervisors: (Contact Name) (Time) (Date) IIEALT�z AN H. 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 B and of Supervisors and to the local health officer. No disclosure of information is required under this subdivision when otherwise prohibited by law, or when law enforcement personnel have determined that such disc losure 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. (c) Any designated government employee who knowingly and intentionally fails to disclose information required to the disclosed under subdivision by imprisonment in the county jail for not more than one year for by mpr sontm n,tbin l, upon conveP statelshed prison for not more than three years. The court may also impose upon the persona fine of not less than five thousand dollars (55,000) or more than twenty-five thousand dollars ($25,000). The felony conviction for violation of this section shall require forfeiture of government employment within thirty days of conviction. I. SIGNATURE DISCLOSURE T make this re ort on behalf of all theesignatcd employees of the County of San Joa uin, and C_ ,< LI Lt (Agency Name Signature: Typed Name. PS -� Title: F F4 S Date: ;? Time: ------------ � � < <� ��.✓►•t JM EH 22 013 (Rev, 2190)