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San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> RE: CERTIFIED LIST OF'RECORD FEE TITLE OWNERS FOR: r <br /> SITE NAME: Pacific Mini Mart <br /> ADDRESS: 4511 Pacific Avenue, Stockton, CA 95203 <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 /> 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 /> 2_ in accordance with Section 25297.15(a)of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> ly n f`s r6/` Z- G�Y/ T _certify I am the sole title owner for the <br /> above site. <br /> Sint, <br /> y <br /> C Signature <br />