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411 <br /> 2315 N. El Dorado St. <br /> Stockton, CA. 35207 <br /> NO.DISCHARGE OF GROUNDWATER OCCURRED AT THIS LOCATION. <br /> DURING (MONTH/YEAR) <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 inquiry of the person or <br /> persons who manage the system,or those persons directly responsible for the information, <br /> the information submitted is,to the best of my knowledge and belief,true,accurate,and complete.I. <br /> am aware that there are significant penalties for submitting false information, including the <br /> possibility of fine and imprisonment for knowing violations. <br /> CORP RATE OFFICER. <br /> PRINT NAME <br /> TITLE <br /> DATE <br />