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f ' <br /> - a <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> �i <br /> Subject: CERTIFIED LIST OF:RECORD FEE TITLE OWNERS FOR: <br /> -� -_ a -- <br /> _ ADDRESS: - Z y K Fa�rd1,n --- S" hy CKfo n <br /> Complete #1 if there are multiple site landowners. <br /> E Complete #2 if you are the sole site landowner. <br /> 3 1. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: ` <br /> I, Sti k �,Wr' t S�' certify,that the following is a <br /> 4 complete fist of current record qe title owners andtheir mailing addresses for the <br /> ` above site: <br /> l <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 /> 1, S%AK wsnkr S;n k' certify I am the.sole landowner for the <br /> above site. <br /> Sincerely, <br /> Signature 'Date <br /> Revised.12/15/09 <br />