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I <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> I <br /> Subject CERTIFICATION OF RECORD FEE TITLE OWNERS FOR PENDING "NO <br /> FURTHER ACTION REQUIRED" (CASE CLOSURE) NOTIFICATION: <br /> SITE NAME. <br /> ADDRESS: I33 a S _5-20A6 <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 Ch pter 6.7 of the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: <br /> I <br /> I, certify under penalty of perjury that <br /> to the best of my (our) knowledge, the followin is a complete list of current record fee <br /> title owners and their mailing addresses forte above site, and that I have notified <br /> each record fee title owner that the Local Oversight Program Case No. on the <br /> site is being considered for a "no further action required" case status (case closure) by <br /> the San Joaquin County Environmental Health Department: <br /> I <br /> I <br /> 2. In accordance with Section 25297.15 (a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> I, S�g„�'te , A&"NJGL V S-d certify under penalty of perjury that to <br /> the best of my knowledgthe sole record itle fee owner for the above site. <br /> CC <br /> �!6�o <br /> ignature _ Date Y <br /> Revised 12/15/09 <br />