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SAN JOAQUIN -w PUBLIC HEALTH SERVICES - ENVIRONMENTAL IiE�— N DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) ReviS 8/26/93 <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 O CASE $ BILLING PARTY Y / N <br /> OWNER NAME SGfP OWNER HOME PHONE <br /> OWNER DBA II ( OWNER WRE/BUS PH ( S/;J S'qI - 367 <br /> OWNER ADDRESS 4 4ULw. .CSt <br /> OWNER CITY I/Q.�I�/M \ STATE f,4_ ZIP G�yG6a <br /> MAILING ADDRESS I CMJL 1 <br /> CARE OF <br /> CITY STATE ZIP <br /> i <br /> BUSINESS CODE NATURE OF OWNER BUSINESS Smlxrmnrke+ LlMivi <br /> FACILITY FILE <br /> FACILITY ID 1 BILLING PARTY Y / N <br /> v k OF EMPLOYEES <br /> FACILITY NAME _S'R401/4 <br /> 'NI EG* Pro oc tci'oyP/"f TRUST LANDS? Y / N <br /> FACILITY ADDRESS I IV Q1/b1 W J'I VZ. HOME PH <br /> CROSS STREET ��('q nN HUHN PH <br /> CITY IULOULL r, STATE C4AL_ ZIP 0(e <br /> Census --------- BOS Dist Location Code City Code ----------- <br /> MAILING ADDRESS iex ((� APN # <br /> CARE OF SIC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY mew} A2 u m,tg <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION AA <br /> NAME I' V'cf Z AM /t SSDSSD e111 C HOME PHONE ( - <br /> MAILING ADDRESS W q ka t7 ,4 Vim- o.,c- DgnN ( ](Jq ) 34,? _ ,uo o <br /> {{]] i11 Uav'c <br /> CARE OF /.'1✓'u <br /> CITY 00111,g STATE ZIP �3�1 2- <br /> � � <br />