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J <br /> 1 <br /> MUM <br /> SEP 013 2013 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 Hazelton Ave <br /> Stockton, CA 95205-6232 <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> SITE NAME: /� — <br /> ADDRESS : / Z� . r ✓ L �h * ' l <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 /> 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 /> I � 0 0 { Y \ vw, certify I am the sole landowner for the <br /> above site <br /> Sincerely, <br /> Signature Date <br />