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San JORquin Caunty <br /> t=nvironmentd Flealth Departmeni <br /> 1668 Flazalton Ave <br /> Stacicton,'CA 95205••6232 <br /> SUbiCci: CEM I IFIED LISA OF RECORD FEE TITLE OWNF_-RS FOR: <br /> SITE E NAME: t RAC`t OrF�G� PL-4z,,1 _ <br /> ADDRESS: 3ZY G I I ik s iMVT _, TRA,,:,Y; CA 9S3 3io— <br /> Complete 91 if thorn are multiple site landowners. <br /> Complote Q if you are fie sole site tandmvner. <br /> 'I. In accordance with Section 25297.'15(@)of Chapter G.7 of the I-lealth&Safety Code. <br /> P3a,�,c c_l F rinlarjr nr 6"XCIV! Nm hj: <br /> 1, 0,M3 aaU-- ceriify that the following is a <br /> complete list Of current record fee title owners and their mailing,.ddresses for the <br /> above site: <br /> ! 2-)u 1 FOX A0. Las <br /> ms c► L i3�.ac� ; Kgi sir_NE $LAGe <br /> t'R wAY, ,_o s GAT u f , eA S S-b 3 U ---- <br /> 2. In accorcance with Section 25297.15(a)of Chapter 6.7 of the Flealih&Safety Code: <br /> Wal-m-,ofRfmc poru..ila69['ariy: <br /> I.— __..-__. certify I am the sole landowner for the <br /> above site. <br /> Sincerely, <br /> Sic naiero B2i2 <br />