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+ SAN 1 s W3. <br /> :4� VIRON�f'sE�1T�Lt-�EI�tiTH N <br /> t,EN PERIfIT�SERu��ES <br /> San Joaquin County ; <br /> Environmental Health Department 4 <br /> 1868 E.-Hazelton AvenueTk .� <br /> Stockton, CA 95205 <br /> ;`Subject:,CERTIFI'ED`LiST OF`RECORD-PE E:TITLE-OWN ERS'FOR <br /> IVAI-VIE: <br /> ADDRESS` 4/23 50 1 S�✓ Sf�,�� � �c� z " � <br /> Complete #1 if there are multiple site landowners. <br /> Complete #2 if you are the sole site landowner. <br /> !. 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, r 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 /> f <br /> j <br /> 2.- In accordance.with Section 25297.9.5(a) of�Chapter6.7 of the Health & Safety Code: <br /> Name of Responsible Party: 1 <br /> ✓�/0C�'f13� q/'Gh� �p f"� CdN 7`C.i�'GhC� CGs7T�i' �� C <br /> certify I am the sole landowner for the <br /> above site. <br /> f Sincerely,. <br /> ignature /� Lr�,//-S Date <br /> Revised 12/15/09 <br />