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i <br /> 4 <br /> lam- <br /> a� <br /> NOV -5 ?J 12 <br /> ENVIRONMENT f"_ALTH <br /> San Joaquin County PERMIT/SERVICES <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 /> 1-0� ���x(:.�2.''y`-1 Lf�g ��r�.S Ss.._..;:-_....--•ter. <br /> ADDRESS: 39 ;:5;- '4 - ` ..`S-4-o.�. �-o,n- <br /> Complete#1 if there are multiple site landowners. <br /> Complete #2 if you are the sole site landowner. I <br /> 1. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: j <br /> Name of Primary or Active Responsible Party: I <br /> I <br /> I, 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 /> d� F <br /> r <br /> OL C c) SA� <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, certify I am the sole landowner for the <br /> abo a site. <br /> Sincerely, <br /> Sign ture Date <br /> Revised 12/15/09 <br />