Laserfiche WebLink
r SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES- ENVIRONMENTAL HEALTH DIVISION <br /> HASTERFILE RECORD INFORMATION FORM EH 01 15 CMNFAC) Revis 5/14M <br /> NEY,FACILITY <br /> � CHANGE OF.OWNER DATE OF OWNER CHANGE _! / INACTIVE ✓ 4 . <br /> Prior Owner <br /> dad. - <br /> ;' UNpEit CONSTRUCTION CHANGE.OF BILLING DATE Of BILLING CHANGE _,/ / DELETE <br /> OWNER FILE <br /> OWNER ID CASE S BILLING PARTY Y / N' <br /> OWNER NAME l �a J�C � �S Q s�YMS - OWNER HOME PHONE ( ) <br /> OWNER WRK/BUS.PH <br /> OWNER DBA ( ) <br /> ADDRESS <br /> CITY STATE ZIP <br /> 1p <br /> MAILING ADDRESS <br /> CARE OF (_�`��� ✓15`��Va�1 � <br /> qz <br /> STATE ZIP —��� ! <br /> CITY- <br /> BUSINESS CODE _ NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> fACILiiY IDS BILLING PARTY Y N' <br /> - OF EMPLOYE <br /> � ES <br /> FACILITY NAME p✓ wn ��S �`f�� t TRUST LAUDS? Y / N <br /> fACiLITY ADDRESS C�S (. icy HOME PH < ) <br /> CROSS STREET 130-( e-,'k re!6,lA BUSH PH ( ) <br /> CITY W d STATE ZIP <br /> Cenum SOS Dist location Code City Code - •-- y <br /> NAILING ADDRESS (1- v �7C�7G =0 APN S �4qq — 630 0 3 <br /> CARE.Of �'�41f2-L 1�. A �.<l �---� SIC CODE <br /> « ZIP <br /> CITY STATE <br /> GENERAL TYPE of BUSINESS at this FACILITY 10 ,2_ <br /> UST,FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> TT IRD PARTY BILLING INFORMATION <br /> NAME NOME PHONE ( ) <br /> NAILING ADDRESS BUSH PHONE ( ) <br /> CARE Of Page 10A <br /> CITY STATE ZIP _ <br /> i <br />