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SAN JOADUI#T PUBLIC HEALTH SERVICES - EXVIROWEMTALft7H DIVISION <br /> NASTERFILE RECORD INFORMATION FCRM EN 01 15 CO.INFAC) R"is 5/14/93 <br /> NEW FACILITY CHANGE Of OWNER DATE OF OWNER CHANGE <br /> - Prior 0~ <br /> ' UNDER CONSTRUCTION �' CHANGE OF BILLING DATE OF BILLING CHANGE _f / DELETE <br /> OWNER FILE - - - <br /> OWNER ID CASE t - BILLING PARTY <br /> OWNER RAME * �MC) -'-y_� 1m-�� ,OWNER NONE PRONE. <br /> OWNER OBA ��' F� fi-4'C:�Jy J b tF•��"vIV:)UL=sJ ' cum 4R1C/BUS PIG C(_ )01 4 <br /> ADDRESS <br /> CITY I.U.` ,"I . .. j. 'j_-STATE "'Y" (v`f ZIP <br /> �-v� <br /> MAILING ADDRESS 1., <br /> ^ � k _ 1j3 J - <br /> . CARE OF `--. 4 tA <br /> CITY - 1 �1�L V ,. STATE l ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE - <br /> FACILITY IQ S _ B)LLINC PART? T ! NFA : <br /> OF EMPLOYEES _ <br /> FACILITY NAME TRUST LANDS? Y ! N <br /> FACILITY ADDRESS ,[1pp `-� �(-+�y/ V•CSV-' ,.�.\� ROME PN <br /> CROSS STREET <br /> BUSH PH (R <br /> CItt STATE ,. ZIP ... <br /> -` Census .»____._ am Dist Location Cade ( ~.�. City Code ---------- <br /> ( z. <br /> MAILING ADDRESS _ APN 0 <br /> CARE OF - - - SIC CODE <br /> CItt - 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 - - <br /> NAME ROME PRONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF <br /> CITY STATE ZIP '� <br />