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San Joaquin County <br /> Environmental Health Department <br /> 1868 Hazelton Ave <br /> StodMon,-CA 95205-6232 <br /> Subject: CEriTIFIED LIST OF RECORD FEE TITLE OWNERS I=Of': <br /> ,SITE NAME: <br /> ADDRESS: <br /> Cornplete M ii there are multiple site landowners. <br /> Compl�.te `2 if you ire the sole site l6ndowner. <br /> '1. In accordance with Section 25297.g5(a) of Chapter"6.l of the i-leatl''th : Safety Cade: <br /> N.-i5ne of Pvinfiary or l-zCfi se RG-SPOU-SiiM9 Pn6tJe <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 /> 2. In accordance with Section 25297.15(x) of Chapter 6.7 of the Health &Safety Code: <br /> certify I am the sole landowner for the <br /> _ J <br /> above site. <br /> Sincerely, <br /> Dai:e <br /> Signature <br />