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RECEIVE® <br /> OCT 25 2011 <br /> ENVIRONMEN"-A HEALTH <br /> PERMIT/SF- CES <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR. <br /> A Li-11i <br /> 'SITE NAME:. <br /> ADDRESS: <br /> Complete #1 if there are multiple site landowners. <br /> Complete #2 if you are the §oie 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 /> 1, 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 />� z <br /> is <br /> I- <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, certify I am the sole landowner for the <br /> above site. <br /> ,E <br /> Sincerely, <br /> Signature +3ZDa <br /> Revised 12/15/09 <br />