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j <br /> fir+` <br /> ,I <br /> i <br /> :i <br /> .SanJoaquin t ounty <br /> E r vironmer"I—HeattFl Department; i <br /> 1460 HAZOWAY0. <br /> Stodkt k.C&i'MR05=6232' <br /> .SubjectsCERTIFIED LIST OF I tECORD Fi5tti `4.OVI WWt=09 <br /> - ._ �+-r.�►2r—. �Nom` S'�°a a :��'�e - <br /> SITE NAME:, <br /> .W4'�e -�.: <br /> Coni plea 0 ifthere.aro rii 1hpiesite landoVi)ners, 95�� � <br /> Comp ew#2 if you'a`re the`sole'Site Iandgwnal'; <br /> 1. in accordance with Sectio"25297.15(a0>of Chapter 6.7 6f the Health&Safety 0406:- <br /> Name of_Pnmary Qr; i giv 7Reepopsible Party: <br /> I, �fi.�� IAW� i .r. :� ' 2?� erUl that the following s a <br /> y 9 <br /> complete hat of current re br l;fee title owners an f their train' addresses for the j <br /> above site.. <br /> VIAi <br /> i <br /> 2. Ina- rdance-wtth Section_Z5"T 5(a}of Chapter 6 7 of the Health&Safety Code: <br /> Name of ResponsibleParty:. <br /> I, certify I am the sole,landowner farthe <br /> above site. <br /> � 5iacerely,_ <br /> I <br /> � ; � .ate � <br />