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SAN JCACUIR COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (O"FAC) Re i• 5/14/93 <br /> NEL FACILITY CHANGE OF OWNER DATE OF OWNER CHANCE / /__ INACTIVE <br /> Prior Ouner <br /> UNDER CONSTRUCTION CNANCc OF BILLING DATE OF BILLING CHANGE / /_ DELETE <br /> CANER FILE <br /> CANER SD CASE K BILLING PARTY / N <br /> 06NER NAME CWNER HOME PHONE C ) <br /> NVER =/BUS PH C�JI(o ) ,I ! v' <br /> OLNER OBA ` <br /> ADDRESS / <br /> 2 I`T V 1" �-CJ� C� S ✓ E CJ <br /> CITY �osa �� STATE ZIP <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CCE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID 7 ( BILLING PART' <br /> Y OF EMPLOTEES <br /> FACILITY NAME �0`II fC�nf o� 1 "'� vr� TRUST LANOS7 T / X <br /> FACILITY ADDRESS \ 1l�Ilr� J5SIU��� •T� GJei` [ HOME PH ( ) <br /> CROSS STREET �I` I� TJT, - 4N(-JD EEL �n a �C_ Bush vx C > <br /> CITY �l�)C. - ` �N STATE EXT ZIP <br /> Census BOB Dist Location C City Code <br /> APN x <br /> MAILING ADDRESS <br /> CARE OF SIC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACIL17T <br /> UST FAC STATUS CODE BUSINESS CGDE ( BUSINESS TYPE (UBT) <br /> THIRD ?ARTY BILLING INFORMATION <br /> NAME HCME PHONE ( ) <br /> MA LL!NG ADDRESS <br /> BUSH PHONE ( )' <br /> CARE OF • Page I0A <br /> CITY STATE ZIP <br />