Laserfiche WebLink
%eD <br /> In <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWIIFAC) Revis 5/14/93 <br /> NEW FACILITY fCHANGE <br /> ANGE OF OWNER DATE OF OWNER CHANGE / / INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> OWNER FILE <br /> [OWNED CASE # BILLING PARTY Y / N <br /> * � u <br /> OWNER NAME OWNER HOME PHONE ( �c� ) -Z07 <br /> o t S1 <br /> OWNER DBA OWNER WRK/BUS PH ( �y )4-b 7 - J�L <br /> ADDRESS 7- �le L/fH W-1 S� <br /> CITY ��IC�Cr, °� STATE ZIP ���07— <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE- ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS r*�U v tom— ��4�✓� ) <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / <br /> # OF EMPLOYEES <br /> FACILITY NAME /7v�C �� Al `` 2 dUOf TRUST LANDS? Y / N <br /> ✓ �4 <br /> FACILITY ADDRESS �r7w�H ' , ' Gtk`�t -/Z:)e,,•AHOME PH <br /> CROSS STREET 1-14 BUSH PH <br /> CITY STATE l ZIP <br /> Census I—BOS Dist location Code City Code ---•------ <br /> MAILING ADDRESS APN # <br /> CARE OF N �Q SIC CODE <br /> CITY C. A STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) J_ <br /> THIRD PARTY BILLING INFORMATION <br /> NAME HOME PHONE ( ) <br /> MAILING ADDRESS BUSN PHONE ( ) <br /> CARE OF Page IOA <br /> CITY STATE ZIP <br />