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.JSi✓.._.-._/3 s:>s...r.�...._..:_ __.� e �,:-_s. ............. <br /> •� <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 E. Hazelton Avenue <br /> Stockton, CA 95205 <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> 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(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: <br /> l 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 /> 2. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> certify I am the sole landowner for the <br /> above site. <br /> Sincerely, <br /> Signature Date <br /> Revised 12/15/09 <br />