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SAN JOAQUIN COUI� PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALS DIVISION <br /> OI 15 (OWN FAC) Revis 8/26/93MASTERFILE RECORD INFORMATION FORM <br /> EN[NEW FACILITY CHANGE OF OWNERDATE OF OWNER CHANGE ���- INACTIVE <br /> Prior OwnerER CONSTRUCTION <br /> CHANGE OF BILLING DATE OF BILLING CHANGE DELETE <br /> OWNER FILE <br /> OWNER ID <br /> CASE I BILLING PARTY <br /> � 7 ' Q � <br /> OWNER NAME -nlA3l'rl OWNER HOME PHONE ( ) <br /> ' <br /> I , C �tt,y5 _ OWNER WRK/8US PH ( ) <br /> OWNER DBA (_,QJ 0 / <br /> %NER ADDRESS <br /> OWNER CITY 1 o I <br /> [' /1 A'"I YCJ STATE C4�- ZIP -3�- <br /> MAILING ADDRESS ��- <br /> CARE OF <br /> CITY STATE /l) ZIP <br /> U <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE- <br /> BILLING PARTY Y / N <br /> FACILITY ID 'W <br /> # OF EMPLOYEES <br /> TRUST LANDS? Y / M <br /> FACILITY NAME <br /> FACILITY ADDRESS HCME PH ( ) <br /> CROSS STREET BUSH PH ( ) <br /> CITY STATE ZIP <br /> Census -------- 30S Dist Location CoOe City CoOe ---------' <br /> MAILING ADDRESS APN d <br /> CARE OF SIC CODE <br /> CITY STATE ZIP I <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING "!FORMATION <br /> NAME HOME PHONE - <br /> MAILING ADDRESS BUSN PHONE ( 1 <br /> GRE OF <br /> CITY STATE ZIP <br />