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• � " fir.✓ � - <br /> 2315 N. El Dorado St. <br /> Stockton, CA. 95207 <br /> NO DISCHARGE OF GROUNDWATER OCCURRED AT THIS LOCATION <br /> DURING (MONTH/YEAR) J `' e, <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. Eased 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 nay knowledge and belief,true,accurate,and complete. t <br /> am aware that there are significant' penalties for submitting false information, including the <br /> possibility of ne and imprisonment for knowing violations. <br /> CORPORATE OFFICER <br /> Cni <br /> PRINT NAME <br /> TITLE <br /> DATE <br />