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i <br /> 2575 Country Club Blvd. <br /> Stockton, CA 95204 <br /> NO DISCHARGE OF GROUNDWATER OCCURRED AT THIS LOCATION <br /> DURING MONTH/YEAR) � e��' `-\[- -zoo J <br /> I certify under penalty of law that this document and all attachments were prepared under my <br /> direction or supervision in accordance with a system designed to assure that qualified personnel <br /> properly gather and evaluate the information submitted Based on my mquny of the person or <br /> persons who manage the system, or those persons directly responsible for gathering the information, <br /> the information submitted is,to the best of my knowledge and belief,true,accurate, and complete <br /> I am aware that there are significant penalties for submitting false information, including the <br /> possibility of fine and imprisonment for knowing violations <br /> • <br /> CORPORATE OFFICER <br /> Denis Brown <br /> PRINT NAME <br /> Project Manager <br /> TITLE <br /> 0 - 6 - o % <br /> DATE <br /> • <br />