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4 <br /> RECEIVED <br /> JUN 17 2013 <br /> ENVIROtllVfr:NTAL HEALTH <br /> San Joaquin County I'Efr'�If7SEs'�t1ICES <br /> Environmental Health Department <br /> 1868 Hazelton Ave <br /> Stockton, CA 95205-6232 <br /> .Subject:—CERTIFIED LIST.-OF,RECORD FEE•TITLE OWNERS FOR.:—y- -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(x) of Chapter 6.7 of.the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: <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 /> 2. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> I, ify I am the sole landowner for the <br /> above site. <br /> Sincerely, <br /> re Date <br />