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ENVIRONMENT HL ALTH <br /> PERMIT/SERVICES <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton,.CA 95202 <br /> Subject CERTIFICATION OF RECORD FEE T TLE OWNERS FOR PENDING "NO j <br /> FURTHER ACTION REQUIRED" (CAESE CLOSURE) NOTIFICATION: <br /> SITE NAME: <br /> ADDRESS: A9 77 G✓. G� ��`e►� CIS �`7-a{ <br /> Complete #1 if there are multiple site record title fee owners. <br /> Complete #2 if you are the sole site record title fee owner. <br /> 1. In accordance with Section 25297.15 (a) of Che pter 6.7 of the Health & Safety Code: <br /> Name of Primary or-Active.Responsible Party: ----- - - <br /> I, V,. Ga, certify under penalty of perjury that <br /> to the best of my (our) knowledge, the following is a complete list of current record fee <br /> title owners and their,,mailing addresses,for tie above:.site,;and.:that,.1-have-notified <br /> each record fee title owner that the Local Over, ight Program Case.No.ISS�--on the j <br /> site is being considered for a "no further action equired" case status (case closure) by <br /> the San Joaquin County Environmental HealthDepartment: <br /> NeG lq-- <br /> 2. In accordance with Section 25297.15 (a) of Cha ter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> I, <br /> certify:under penalty of.perjury that to <br /> the best of my knowledge-I am the sole record#tle_fee owner forthe;aabove site,;,, <br /> Signature Date <br /> Revised 12/15/09 <br /> •i I <br />