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2315 N. El Dorado St. <br /> Stockton, CA 95207 <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 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 /> CORPORATE OFFICER <br /> no <br /> PRINT NAME <br /> TITLE <br /> D&E <br /> i <br /> i <br />