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SAM JOAQUIN *Y PUBLIC HEALTH SERVICES - ENVIRONMENTAL NON DIVISION <br /> MASTERFILE RECORD INFORMATION FCRN EH 01 15 (WNFAC) Rwts S/14/43 <br /> NEN FACILITY CHANGE OF OWNER DATE Of OWNER CHANGE <br /> Prior 0~ <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE <br /> OWNER FILE <br /> OWNER ID CASE 0 BILLING PARTY <br /> DINER NAME F"`�n�T�E/ G Q S `J I V RLI-S, [1 PS5 lit n I �/� OWNER .— PHONE (. )— <br /> OWNER DBA /' 6 ?L- — �1-V C'��17--`'I� (�.'Y� SCt� I�-1��� 06WER VRKK'/�8US PH (5 <br /> ADDRESS '� � ��. ( A i C.� P { ✓tea n �' <br /> CITY _SL ala GF ! C/ reef:� STATE _C tq_ ZIP <br /> NAILING ADDRESS <br /> CARE Of <br /> CITY STATE // ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS U 1 ( I t <br /> FACILITY FILE <br /> FACILITY ID f BILLING PARTY Y / N <br /> //�`,(� p� ((�� .L ! Of EMPLOYEES <br /> FACILITY NAME PG t E _ I IILI'I Mdll6n 1.1 e,11y�,NjC)r.StC� }ire V) TRUST LAIR)ST Y /9 <br /> NcStree�adt{reSS /^� 2 CC p <br /> FACILITY ADDRESS (�, rpo�^ Li,)Cky ( J 3 1^11 je,JSo a 1-L, c'/ I''C'P"l' Ill RLQ! , HOME PH ( 7 <br /> CROSS STREET �r%I /) �L7 I BUSH PH <br /> L 5 /1 N i lnen 5 5 0--1 i4L c s F c 0 <br /> CITY MCI CI n f e Lcl STATE C � ZIP <br /> Census --------- BOIS Dist Location Code City Code -• •-.t..-Z. <br /> MAILING ADDRESS /A (,qme C` ARN-! 135-361- I,1.J —I <br /> GRE Of 196 G �C/S sLia�, L� C�y� n l SIC CODE <br /> CITY _lam Il it C,tC STATE CA Z)P945i� -Zyl�L / 1 / / <br /> GENERAL TYPE of BUSINESS at this FACILITY /1)n+ural (ia5 I)e HX61Ncl C(`,5 ke?r/pn <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> NAME HCME PHONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF AI11k Page IOA <br /> CITY STATE ZIP • <br />