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i <br /> r . V 2009 <br /> BVIRGNP6ENT HEALTH <br /> 1 <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 E. Main Street <br /> i Stockton, CA 95202 <br /> RE: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> SITE NAME: Jay's Mini Mart <br /> i <br /> ADDRESS: 3302 West Lane, Stockton, CA <br /> Complete #1 if there are multiple site landowners. <br /> Complete #2-if you-are.the sole.site landowner. <br /> 4 _ <br /> i <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, G / certify that the following is a <br /> l , <br /> complete list ofcurrent record fee title owners and their mailing addresses for the <br /> ove site:'* <br /> a2.--1n accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: p <br /> r ` ' Name of Pa Responsible-Patty: <br /> I, ` certify I am the sole title owner for the <br /> above si . <br /> Sincerely, <br /> Signa e <br />