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SAM JOAQUIN S PUBLIC HEALTH SERVICES - ENVIRONMENTAL HF00IVISION 8 5� <br /> MASTERFILE RECORD INFORMATION FORM EN 01 15 (OWNFAC) Rwis 5/14/93 <br /> MEN FACILITY CRANGE OF OWNER DATE Of OWNER CMAIGE /_ / INACTIVE <br /> Prior Owwr <br /> UNDER CONSTRLX;TION CHANGE OF SILLINO DATE Of BILLING CHANCE / / DELETE <br /> OWNER FILE <br /> OWNER IO CASES BILLING PARTTY� QTQ / NN <br /> MJ L V J12C1'_IS�S�1. <br /> OWNER NAME l�T/T�G G Q S C��J fI��i �I W S Ll R (� OWNER XOFIE PHONE ( ) <br /> OWNER DSA /'n1p 4— /1 ry1- I OWNER NRXX � <br /> /BUS PH ( ) 1 - <br /> ADDRESS ,/L'11�1� . I �/ i f7 .{ ✓`a n 5 u i �e 2-0 <br /> CITY lNL(IA44 f 0reek STATE zip , 5j ? - ,2 44, <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWER UINESS U IL ' V 0-Q M ^ A <br /> FACILITY FILE <br /> FACILITY ID S % BILLING PARTY Y / N <br /> N OF EMPLOYEES <br /> FACILITY NAME PC--+E �/C_R L"1$ Lt-of'YD"70& S— rJ,.Y TRUST LANDS? T <br /> NASrr Oc{ress <br /> ADRES <br /> FACILITY ADDRESS /•O hi,A:$ SOuTy eG -pc-1P.H4H gpfp c�- t> A7 Ra9D HOME PN ( <br /> CxNren 1.4 hf yrs eys> av PWeILR44C, <br /> CROSS STREET /� BUSH PH <br /> CITY f'N tC4.S St OF -rA.,4ey LI <br /> STATE T ZIP <br /> Census I •---•---- I SOS Dist Location Cade City Code ......... <br /> MAILING ADDRESS /A Q N APN S <br /> URE Of 196 It G Go ;Li a `/)eSS l)I i pSICC CODE/I <br /> CITY Ia1,�J ��� ,re STATE CFl ZIP I� 53 -�q/ / 1 / <br /> GENERAL TYPE of BUSINESS at this FACILITY fn)afG(ref (7a5 nC NxL1 Nq ICIAS >`"Ll TION <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> NAME NOME PHONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF Page 10A <br /> CITY • STATE ZIP • <br />