Laserfiche WebLink
7 <br /> SAN JOADUIN NTY PUBLIC HEALTH SERVICES - ENVIRONMENT _ <br /> NTAL'� LTH DIVISTON- <br /> - <br /> MASTERFILE RECORD INFORMATION FORM +' <br /> _ EH 01 15 (WNFAC) -RevYs^9¢26/-Q3 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWNER CHANGE / /_ INACTIVE --- + <br /> Prior Owner <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> OWNER FILE _ <br /> OWNER ID `f L <br /> 7 7 CASE # BILLING PARTY <br /> OWNER NAME OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH ( ) <br /> OWNER ADDRESS ` `^CC- <br /> OWNER CITY /�y--/'1`Ty / (= G 7¢ Ir\u '� STATE ZIP (! <br /> MAILING ADDRESS v <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # -�Cl BILLING PARTY Y / N <br /> # OF EMPLOYEES <br /> FACILITY NAME TRUST LANDS? Y / N <br /> FACILITY ADDRESS �. C1 t� - C Is. ro Q S HOME PH ( ) <br /> CROSS STREET G IZ/f �T BUSH PH ( ) <br /> CITY M f4 A) ?rE[ A STATE ZIP <br /> Census --------- BOS Dist Location Code City Code ---------- <br /> MAILING ADDRESS APN # <br /> CARE OF SIC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION I <br /> NAME WNf Y= ^) VIR0N -, F--7✓jL HOME PHONE ( oF) S�9- /38 <br /> MAILING ADDRESS P, V U h G 7 Zy BUSH PHONE <br /> CARE OF S GIIP <br /> CITY /39 U IJ ! IT STATE �/' yT ZIP �S SAJ <br />