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SAN JOAOUINITY PUBLIC HEALTH SERVICES - ENVIRONMENTAL FH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) Revis 5/14/93 <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 /> i <br /> OWNER ID CASE # BILLING PARTY Y / N <br /> OWNER NAME A wle_, /l G C.', V L A f,4 %CdA& L OWNER HOME PHONE <br /> OWNER DBA OWNER WRK/BUS PH <br /> 1 (71 )2SZ- G4 3 <br /> ADDRESS 1 8 1 Ua1i1 1Cota_w.c- 'av�& -CLtyuy <br /> k <br /> CITY ZY-Vl ,X STATEl�F, ZIP 920 y <br /> MAILING ADDRESS r-► ( m <br /> CARE Of ^�\ /� <br /> CITY c1�I('1)I(/._ STATE l ,L _ ZIP C� 2'-7 1 <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / N k <br /> # OF EMPLOYEES <br /> I! j <br /> FACILITY NAME L..L C..,��T!-EOI.�S �G L-la 'CJ C_ TRUST LANDS? Y / N <br /> n I <br /> FACILITY ADDRESS Z HOME'PH <br /> �i <br /> CROSS STREET 1 lDCP Z,%SO Iq l�C/�G, BUSN PH <br /> CITY GL� STATE 2IP <br /> E <br /> sus - SOS Dist Location Code. City Code ----------- <br /> - j <br /> -- 0 1 <br /> MAILING ADDRESS APR # <br /> CARE OF SIC CODE <br /> CITY 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 HOME PHONE ( ) <br /> C ) <br /> MAILING ADDRESS BUSN PHONE (J�' <br /> CARE OF <br /> CITY STATE ZIP <br />