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San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> Subject CERTIFICATION OF RECORD FEE TITLE OWNERS FOR PENDING"NO <br /> FURTHER ACTION REQUIRED"(CASE CLOSURE)NOTIFICATION: <br /> SITE NAME: <br /> ADDRESS: (t DL-e ft St S-r DC1 fon .On <br /> Complete#1 If there are multiple site record title The owners. <br /> Complete#2 If you are the sole site record title fee owner. <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, 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 the above site, and that 1 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 /> 2. In accordance with Section 25297.15(a)of Chapter 6.7 of the Health&Safety Code: <br /> Name of Responsible Party: <br /> I, Veit 4 A . 61.4 certify under penalty of perjury that to <br /> the best of my knowledge I am the sole record title fee owner for the above site. <br /> ht a 6 1-1 - 4 - c010 <br /> Sign re Date <br /> Revised 12/15/09 <br /> i <br />