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- 1 r <br /> r. <br /> San .Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> Stockton, CA 95202 <br /> RE: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FR: f31"1 LJ <br /> SITE NAME Pacific Mini Mart AUG 2 � Z009 <br /> ADDRESS: 4511 Pacific Avenue, Stockton, CA 95203 ENUCUkAENT HEALTH <br /> Complete #1 if there are multiple site landowners. pMr, ;T1;,ERVICE' <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(x) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Responsible Party: <br /> 1, /)1_97*K L- M /f/T certify I am the sole title owner for the <br /> above site. <br /> Sin <br /> .y <br /> Signature <br />