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• SAN JOAQUIN COUP PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEA . DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) Revis 8/26/93 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWNER CHANGE / /_ INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE f /_ DELETE <br /> OWNER FILE <br /> OWNER ID CASE # BILLING PARTY Y / / N <br /> u77J y <br /> OWNER NAME OWNER HOME PHONE f ) <br /> fff <br /> OWNER DBA OWNER WRK/BUS PH ( ) <br /> OWNER ADDRESS ��/��a/e(F �/`"'�J �J <br /> OWNER CITY /7 /n� /t/tel. -Y STATE ,6 �f} -5 <br /> <ZIP —33(/J <br /> MAILING ADDRESS v �/� <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # �O -� BILLING PARTY Y / 'W\ <br /> # OF EMPLOYEES <br /> FACILITY NAME 10 <br /> T — TRUST LANDS? Y I N <br /> FACILITY ADDRESS �SO / /" \ HOME PH ( ) <br /> CROSS STREET ✓tel ' -y BUSH PH <br /> CITY STATE '�! ZIP <br /> i <br /> Census 30S Dist location Code City Code ---------- <br /> MAILING ADDRESS APN # <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 /> NAMEd'IJ,;� HOME PHONE <br /> MAILING ADDRESS 3 `�' BUSH PHONE f ) <br /> CARE OF _ ' <br /> CITY ON STATE \Jr' ZIP I��� <br />