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8an Joaquin County <br /> Environmental Health Department <br /> 1868 Hazelton Ave <br /> Stockton, CA 95205-6232 <br /> Subject: CEITUIED LIST OF REG(.) !"ITLE <br /> SITE NAME, <br /> ADDRESS: <br /> Cornplet e#1 it there are multiple site landowners. <br /> Complete 442 if you are the sole site landowner. <br /> a a <br /> In accordance with Section 25297 A 5(a) of Chapter 6.y of the Health 8-It S f(ty C od, - <br /> Namcg, of Primary or Activo Responsiblo Parym <br /> ceilify that the following is �x <br /> conipe list aF current record fee title owners and their mailing addresses for thc-',� <br /> above site: <br /> Sg <br /> 2. Ili accordance with Section 25297,15(a)of Chapter 6.7 of the Health & Safety Code: <br /> Nato$of Responsible Party: <br /> landowner for the <br /> certify I am the sole <br /> tabove'dite, <br /> Sincerely, <br /> Date <br /> Signature <br />