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e _ <br /> 2315 N. El Dorado-St. <br /> Stockton, CA 95207 <br /> NO DISCHARGE OF GROUNDWATER.OCCURRED AT THIS LOCATION <br /> DURING (MONTHIYEAR) ( C,�'1 , o�001 <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 gathering 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 /> coRP6RATE OFFICER <br /> PRINT NAME <br /> TI'T'LE <br /> DATE <br />