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Nov- 18-98 12 :43P • P - O"L <br /> SAN JOADIIiN COUNTY "LIC HEALTH SERVICES - EN4IRCNMENTAL HEALTH DIVISION <br /> NASTERFILE RECORD INFORMATION FORM EH 01 15 (tW11FAC) Revie 5114)93 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWER CHANGE J /„ INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION CHANCE OF BILLING DATE CF BILLING CHANGE / /� DEifiE <br /> OWNER FILE <br /> OWNER ID CASE A SILLIHG PARTY Y ! 4 <br /> sE L.�6s;1`,�� ! <br /> OWNER NAME OWNER HONE PRONE ( `�<9 <br /> OWNER DBA __— �C7Ydwit W�RK/HUS 94 <br /> ADDRESSjfl(.2�(., <br /> no U CITY ` e b'� STATE ZIP ` `,$ 3 <br /> P�1,'1v/YJvNAILING ADDRESSC/�{};c� <br /> CARE OF /t.� '1i1 �/� ,} /�7�^V�F/J t'G/C/,� .�-• // <br /> CITY STATE Z)PL O G <br /> � <br /> BUSINESS =1 ° �% NATURE OF OWNER BU5INESS � -Sj-S C4 V/CE.0 <br /> t�1.�✓T�� '�T �J �If1CL(✓��J <br /> FACILITY FILE <br /> FACILITY 10 R BILLING PARTY Y / <br /> _ iZ A OF EMPLOYEES /&14: <br /> FACiLITT NAME Z14 f-�SS E///Jn L� !� / �'�/`�•" TRUST LANOS7 Y <br /> FACILITY ADDRESS XCNE PH C ) <br /> CRCSS STREET " �1i� BUSH PH ( Y ) <br /> CITY �L/F�pV T��/T STATE G ZIP 'J J 7 <br /> Census •-•----•- I BOS Dist Location Code City Code -•-•--••-- <br /> MAILING ADDRESS _. lG��'EJ /-&,41z5;dyj Wl�� APN A ZZ-I <br /> CARE Oi `/�-/r, .}��JE�.�{•p� �/I� p-¢) .,/� /� SIC CODE <br /> CITY 3J�Y�J L.L/Q J�-- STATE (244— ZIP (,) � <br /> GENERAL TYPE of BUSINESS at this FACILITY `. S <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> TNIRO PARTY EILLING INFORMATION Ar,�. <br /> NAME /fir L.E <br /> , ES l 1�')� ._L-R^L> NCME PHONE C ) <br /> NAIL'NG ADDRESS C/JlnD�b�y/J,� V✓ BUSH PKINE ( ) <br /> CARE OFA`"/-C//��'/��"�v`-�" <br /> STA1E ( A ZIP 5 <br /> 0�`/� <br />