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I4 <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E.Main Street <br /> Stockton,CA 95202 <br /> F Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> --r u G <br /> SITE NAME: ' ! <br /> ADDRESS: 9C7 /9 U !2�'r G( o <br /> l 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 /> I <br /> I, certify that the following is a <br /> complete list of current record fee title owners and their mailingaddresses for the <br /> above site: /� r <br /> !i dj <br /> 2. In accordance with Section 25297.15(a)of Chapter 6.7 of the Health&Safety Code: <br /> Name of Responsible Party:'; . <br /> 1. certify I am the sole landowner for the <br /> above site. ; <br /> Sincerely, <br /> y <br /> Signature Date <br /> Revised 12115M ''e <br />