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Valley Pacific Petroleum Services Stockton,CA <br /> Spill Prevention,Control,and Countermeasure Plan <br /> Monthly Record <br /> I certify under penalty of law that I have personally examined and am familiar with the required Monthly Inspection. I <br /> believe that the information is true, accurate, and complete. I am aware that there are significant penalties for <br /> submitting false information, including the possibility of fine and imprisonment. <br /> Name Title Signature Date Record# <br /> (yr Imo.) <br /> 1/1 <br /> 1/2 <br /> 1/3 <br /> ...................................................... <br /> 1/4 <br /> .................................................................................. .....,...............................,.............................................................. <br /> 1/5 <br /> ........................................................ <br /> 1/6 <br /> .................................................................................. ......,...............................,............................................................... <br /> 1/7 <br /> 1/8 <br /> 1/9 <br /> ........................................................ <br /> 1/10 <br /> .................................................................................. .....,...............................,............................................................... <br /> 1/11 <br /> 2/1 <br /> .................................................................................. ......,...............................,...................................................... <br /> 2/2 <br /> .......................................................................... ......................................... <br /> 2/3 <br /> .................................................................................. ......,............................................................................................... <br /> 2/4 <br /> ........................................................................... .................................................. <br /> 2/5 <br /> .................................................................................. ......,...............................,...................................................... <br /> 2/6 <br /> 2/7 <br /> 2/8 <br /> 2/9 <br /> 2/10 <br /> 2111 <br />