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/X/ l/ J�12-1 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH 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 /> OWNER ID � CASE # BILLING PARTY Y / N <br /> OWNER NAME v �N �Y�O ` � OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH ( ZC9 ) 9�4 _ 653 y <br /> ADDRESS ?C� IV �( Do-KeCU-0 strzef BILA, <br /> CITY SfocKfcw STATE ell ZIP 95X'2 - 230 , �—�v- <br /> MAILING ADDRESS <br /> CARE OF / '/� .Q�l SfT ,e <br /> CITY ✓P STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS LV`z 4"uef'l,"ylvAl <br /> FACILITY FILE <br /> FACILITY ID # c " BILLING PARTY Y / <br /> /�,4lvlv�� /.SGAWy, # OF EMPLOYEES <br /> FACILITY NAME TRUST LANDS? Y / N <br /> FACILITY ADDRESS/ ef-e-`L � f HOME PH <br /> CROSS STREET BUSH PH <br /> CITY STATE C4 ZIP y5202 <br /> Census I --------- I BOS Dist Location Code City Code --------- <br /> - <br /> MAILING ADDRESS >�5 /y� G� �GTLLQC ll�e�tr , LIQ '20C AP # l3 Z 02- <br /> CARE <br /> 2CARE Of �0�2�� ��✓��� / 6/rt6�-yC�fih/ SIC CODE <br /> CITY � �"� STATE ZIP 5—02 <br /> GENERAL TYPE of BUSINESS at this FACILITY etRPEN'TLY UNPEVE"LOPEA <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> NAME HOME PHONE ( ) <br /> MAILING ADDRESS BUSN PHONE ( ) <br /> CARE OF <br /> CITY _ STATE ZIP <br />