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r <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 Amer <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> OWNER FILE <br /> OWNER ID a CASE 0 BILLING PARTY Y / <br /> OWNER NAME l.T,�CGGJ ( 4A/k ,t ..t- OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH ( f I ) 21/ - A-12-3 <br /> ADDRESS <br /> CITY F! SGE-U��'(� - STATE ZIP Zr <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID N 7-5 BILLING PARTY T <br /> Y / <br /> 7 <br /> &64^-/�/ vP/ZCSS X OF EMPLOYEES <br /> FACILITY NAME / /i ! �f OF <br /> LANDS? Y <br /> FACILITY ADDRESS �`©� l E' L '{` HOME PH ( ) <br /> CROSS STREETy`'C� "'G BUSN PH ( ) <br /> CITY �llx �� STATE ��- ZIP <br /> [__!elsus --------- BOS Dist Location Code City Code ----------- <br /> MA M NG ADDRESS APN 'S <br /> CARE OF SIC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> NAME - cj /��✓L�/��61/�E� �— HOME PHONE <br /> MAILING ADDRESS �YC � j / SL (7E BUSN PHCNE ( 5�U ) . LD <br /> l r <br /> CARE Of " f r' Page I <br /> CITY Ce IV-` STATE ZIP <br /> I <br />