Laserfiche WebLink
eKrKaEW <br /> SAN lOA0U .0UNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL H DIVISIONMASTERFILE RECORD INFORMATION FORM EN 01 15 (C1INFAC) Revis 5/14/93 <br /> LITY 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 0 BILLING PARTY Y <br /> / N i <br /> kft �Ett NAME 1 F SM4OWNER HOC PHONE9 <br /> V Q�,1 OWNER DBA OWNER WRK/BUS PH <br /> ADDRESS tG b l 11 O Gx (2/p, <br /> _...CITY. 1 f?c�L 1 D -..w:- ...STATE-.(lIfi ✓ep- <br /> MAILING ADDRESS <br /> J51 <br /> CARE OF <br /> CITY STAIE ZIP r 2-300 <br /> 5.4 BUSINESS CODE NATURE OF OWNER BUSINESS L414 TVId k 1190-14 fc.+rcf� <br /> FACILITY FILE t <br /> FACILITY 10 # DZo 1-3BILLING PARTY Y / <br /> r a# OF EMPLOYEES <br /> FACILITY NAME VLA TRUST LANDS? Y / N <br /> FACILITY ADDRESSG � s nFG HOME PH ( . ) <br /> /fG � <br /> CROSS STREET •• '/• BUSH PH ( ). <br /> CITY STATE ZIP <br /> ,Census _ ......... <br /> . �BOS Dist_ -- -Location Coco._- City Ccde •-w <br /> MAILING ADDRESS APR 0 <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 O <br /> NAME HOME PHONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF <br /> CITY STATE ZIP <br />