Laserfiche WebLink
ti SAN JOAGUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> KASTERFILE RECORD INFORMATION FORM EH 01 IS (OWNfAC) Revis 5/14/93 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWNER CHANGE / INACTIVE <br /> Prior owner <br /> UNDER CONSTRUCTION CHANCE OF BILLING DATE OF BILLING CHANGE / _f DELETE <br /> OWNER FILE <br /> OWNER IO CASE 0 8ILLING PARTY Y / iI <br /> --� OWNER NAME 044!d 1?CI Q r eF OWNER HOME PHONE ( ) <br /> OWNER DBA ` OWNER WRK/BUS PH <br /> ADDRESS -37 / 7 (JT�L .,.../%G e„ <br />-- --- _CITY _ - �T_•. O'y!S �^^ STATE ZIP <br /> MAILING ADDRESS <br /> CARE OF A M M a, Cif'^+Q 441-1. <br /> CITY ...,_ _ ..�. <br /> STAIE � ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / !" <br /> # OF EMPLOYEES -951;2 <br /> FACILITY NAME ruc or le jo KW t C a Y CI TRUST LANDS? Y / N <br /> FACILITY ADDRESS HOME PH <br /> CROSS STREET _ l�wl,!d ^7 - .. _ BUSH PH ( ) <br /> CITY - *- -- -� <br /> STATE 2[P <br /> Cetlsus --------- SOS Dist Location Code City Code ------ <br /> MAILING ADDRESS .. �O 13 ox f0 Y'S _ .. APH It <br /> CARE OF _ n�G� _-___ -•... fX„_i ev ce-w SIC CODE <br /> CITY S1 G d/// S TT STATE ZIP !i 3�l► -3 .Z L/ <br /> GENERAL TYPE of BUSINESS at this FACILITY go�+� !/ <br /> UST FAI: STAWS ME BUSINESS CODE BUSINESS TYPE (UST) <br /> _J <br /> �,41 THIRD PARTY BILLING INFORMATION <br /> NAME �p� ��(!S G 14”iif!/l etO 3r.-W 64 71 I �'�I G HOME PHONE <br /> MAILING A©DRess _a-93?_ _l��yf� JQ�? Al—e, _ .�_��_ SUSN PHONE ('319f <br /> CARE OF ✓rr LCt'�► 7 �r G Page ]OA <br /> C17Y Y� -- - STATE G � ZIP �3 5-w"' <br /> - <br /> - =A <br />