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San Joaquin County <br /> Environmental Health Department <br /> 1868 Hazelton Ave <br /> Stockton, CA 952.05-6232 <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> SITE NAME: <br /> ADDRESS: <br /> Complete if there are multiple site landowners. <br /> Complete at2 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 Activc Responsible Pan=ty: <br /> I ceilify 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(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> I, — certify I am the sole landowner for the <br /> above site. <br /> Sincerely, <br /> �IC;iI211i1'P. <br /> Postal <br /> CERTIFIED MAIL RECEIPT <br /> O (Domestic Only; <br /> r-a <br /> r� $ <br /> D' Postage <br /> M <br /> rTl Certified Fee <br /> Postmark <br /> C:) Return Receipt Fee 0 Here <br /> E3 (Endorsement Required) <br /> O <br /> O Restricted Delivery Fee <br /> (Endorsement Required) <br /> C3 <br /> III Total Postac <br /> ru <br /> ru serrro Charan Singh Dhillon Etal <br /> m 2057 S. EI Dorado St. <br /> r-i Streei,ApENi Stockton, CA 95205 <br /> r3 or PO Box No, <br /> r� City State,ZIf <br /> COMPLETE • ON DELIVERY <br /> COMPLETE • <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Re'3tricted Delivery is desired. ❑Agent <br /> ■ Print your name and address on the reverse X El Addressee <br /> so that we can return the card to you. g, y(Printed Name) C. Date of Delivery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. D. Is d 1 [3Yes <br /> Wea <br /> 1. Article Addressed to: If YE ,en er ess be ov ❑No <br /> NOV 03 14 <br /> Charan Singh Dhillon Etal <br /> 2057 S. EI Dorado St. <br /> Stockton, CA 95205 3. Ice Tj I , ERvn rr' <br /> 7Certified Mail® 0 Priority Mail Express- <br /> 11 Registered ❑Return Receipt for Merchandise <br /> 1 <br /> 1:1 Insured Mail 11 Collect on Delivery <br /> /� <br /> �)L 7 Sa.1 n � 4. Restricted Delivery?(Extra Fee) 13 Yes <br /> 2, Article Number ���VVV 7013 2250 0000 3397 9410 <br /> (transfer from service label) —_ <br /> PS Form 3811,July 2013 Domestic Return Receipt <br />