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1' <br /> i <br /> J <br /> .y <br /> I <br /> San Joaquin County <br /> Environmental Health Department - <br /> 1868 E. Hazelton Avenue <br /> Stockton, CA 95205 <br /> I <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> SITE NAME: <br /> ADDRESS: <br /> Complete#1 if there are multiple site landowners. <br /> Complete#2 if you are the sole site landowner. <br /> 1. In accordance with Section 25297.15(a)of Chapter 6.7 of the Health & Sz_'ety Code: <br /> Name of Primary or Active Responsible Party: f <br /> I, certify that the following is a <br /> complete list of current record fee title owners.and their mailing addresses for the <br /> - above-site: <br /> I <br /> i <br /> I <br /> I <br /> 2. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> I <br /> f <br /> certify i am the sole landowner for the, I <br /> above site. <br /> Sincerely, <br /> Signature Date <br /> Ii <br /> 1 Revised 12/15/09 <br />