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San Joaquin County <br />Environmental Health Department <br />1868 E. Hazelton Avenue <br />Stockton, CA 95205 <br />Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br />SITE NAME: <br />ADDRESS: <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 />above site. <br />Sincerely. <br />Signature <br />Revised 12/15/09 <br />certify I am the sole landowner for the <br />Date <br />