UST Program - LG 158 - Sample Letter 2

Name of local agency

Street address

City

SUBJECT: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR SITE NAME AND ADDRESS

Fill out item 1 if there are multiple site landowners. If you are the sole site landowner, skip item 1 and fill out item 2.

1. In accordance with section 25297.15(a) of Chapter 6.7 of the Health & Safety Code, I, name of primary responsible party, certify that the following is a complete list of current record fee title owners and their mailing addresses for the above site:
2. In accordance with section 25297.15(a) of Chapter 6.7 of the Health & Safety Code, I, name of primary responsible party, certify that I am the sole landowner for the above site.

Sincerely,

Signature of primary responsible party

Name of primary responsible party