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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH 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 CASE # BILLING PARTY Y / N <br /> V <br /> OWNER NAME i,7 aG ► y C" q) ��` OWNER HOME PHONE <br /> OWNER DBA OWNER WRK/BUS PH <br /> OWNER ADDRESS <br /> OWNER CITY -7S 10 <br /> STATE � ZIPy ;-10 v <br /> MAILING ADDRESS _ e:,,S e— <br /> CARE OF le <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / N <br /> # OF EMPLOYEES <br /> Y N <br /> FACILITY NAME �/J[�1PaC 1�1 C /�(�� / 7 — r`�OT + �� " TRUST LANDS? / <br /> t" r HOME PH ( ) <br /> FACILITY ADDRESS <br /> BUSN PH ( <br /> CROSS STREET l ) /" <br /> T►-- <br /> CITY �' � <) STATE ZIP �ya + <br /> Census ----------- 130S Dist �} Location Code City Code ----------- <br /> /-JC '(I'(- <br /> MAILING <br /> ic-MAILING ADDRESS //C APN # <br /> CARE OF /" �O^ \ 1 d✓� 'T/�k! SIC CODE <br /> CITY /c1 f"/G�01r STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODEF77 BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> mm _ HOME PHONE <br /> MAILING ADDRESS BUSN PHONE <br /> CARE OF <br />