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MASllz "ALL RECORD INFORMATION F 0 ' <br /> SWEEPS— <br /> Kim Co tr Prog/Sub Elem Conv,.wwNo <br /> E .H . (assigned by clerk) <br /> P/L�1� Local Com Number Su is Loca ion ICodeFe❑ <br /> 0 <br /> Previous Camp. NUMOEN Effective oaN Other Program Activity <br /> SITE NAME (00 crewcut.) _ <br /> s+rEAddr_esL(no–teir/Sireet/SuMx/Suite) litterty/Statell I p -- - <br /> 1 <br /> PREVIOUS DBA <br /> Billing flame <br /> Billing Address (No/Dir/Street/Suffix/Suite) 811111 ng- CIt /State/Zi <br /> Est SIZE 54TE TEtEPnONE HUMBEH <br /> 0 Seats <br /> —FT71❑❑—J /9Unttstts Y ❑�L❑ <br /> 0wr4FA KA.sAE (Ja crw to e) <br /> OWNER Address (No ./Dir/Ctreet/Suffix/Suite) Omer City/State/Zip <br /> SPECIAL PROGRAM INFOR.!1ATION No.of s4MC* Sowce of Treatment population <br /> Conneetlont SUPCAy Type Ir Served <br /> Rdc. Health Water FM l�❑❑ <br /> ADDITIONAL COMMENTS : <br /> San, sup. AC SC <br /> ❑ ❑ ❑ 0 <br />