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Inspector Name and Title Inspector's Employer and Address <br />VIII. Certification: <br />I hereby certify, under penalty of perjury, that the information presented in this report and <br />attachments is true and complete: <br />Signature of Property Owner or OtherResponsible Party Date <br />Type or Print Name <br />Company Name <br />Address <br />Phone number: <br />ATTY/AGR/2017.072/STANFORD - STMMA <br />REV: 04-05-17 PR <br />Email: <br />