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�€ r <br /> F <br /> A <br /> 1 <br /> San Joaquin County <br /> Environmental Health Department <br /> : 600 E.Mein Street <br /> F Stockton, CA 95202 { <br /> SubJect: CERTIFIED LIST OF RECORD EEE TITLE DWNERS FOR: <br /> s <br /> SITE NAME: Ii1Ar�e l� `N; �a a <br /> ADDRESS: 130 1 W . 4- ._ .£ . L•©v <br /> 1 <br /> 5 <br /> Complete#1 if there are multiple site landowners. <br /> d Complete#2 if you are the sole site.landowner. <br /> I. In accordance with Section 25297.15(a)of ChaPt r 6.7 of the:Health&Safety Code: <br /> l arrto of Primary of Active Responsible Party: <br /> I, FV TF, Qs F,G . .�! certify that the following is a. <br /> j complete fist'of current record flee-title owners and their Mailing addresses for the <br /> above site; <br /> SS fP LA-N F <br /> ` I L ► �} _ 9 S Z <br /> 97-- <br /> 2. <br /> ;lz- <br /> 2. In accordance with Section 25297.15(a)of Chapte 6.7 of the Health&Safety Code: <br /> i Dame of Responsible Party: <br /> I certil y I arra the sole landowner for the <br /> above site. <br /> 3 <br /> Sincerely; <br /> Signature tate <br /> IRebised 12115/09 <br />