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RECEIVE <br /> JUN 3 1 2012 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br />� Subject: CERTIFIED LIST O' RECORD TITLE OWNERS FOR: <br /> SITE NAME: I � / ✓�/G�� � � <br /> -� - 3–= - -�ADDRESS � � .. <br /> t . <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 Primaiv or Aeove Responsible Party: <br /> I, certify that the following'is a <br /> I'I complete r3ttx cur ent record fee title owners and their mailing addresses for the <br /> above site, <br /> G � _ t <br /> 2. In accordance with Section 25297.15(a7of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> �' �<i✓ I 1 certify I am the sole landowner for the <br /> f above site. <br /> ik Sincerely, <br /> i - - <br /> i <br /> r Sin re Date — <br /> Revised 12/15/09. <br /> if <br />