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i <br /> 610 North Hunter Street <br /> Stockton, California 95202 <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 <br /> information, the information submitted is, to the best of my knowledge and belief, true, accurate, <br /> and complete I am aware that there are significant penalties for submitting false information, <br /> including the possibility of fine and imprisonment for knowing violations <br /> ORPORATE OFFICE <br /> PRINT NAME <br /> TITLE <br /> 1z�ro�ay <br /> DATE <br /> ir✓+r <br /> f7 r 44 <br /> 4 <br /> 6 <br /> S 1625961reportshraterdischaree110_04 doc 2 �Y <br />