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,. • �nv� of ���i � <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH 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 _�_�._— DELETE <br /> OWNER FILE <br /> OWNER ID CASE # BILLING PARTY Y / N <br /> OWNER NAME <br /> OWNER HOME PHONE ( ) <br /> ,�pp '' <br /> OWNER DBA G 1�w11 OWNER WRK/BUS PH ( ) <br /> OWNER ADDRESS <br /> OWNER CITY o. 1 '\B � STATE ZIP <br /> �'ILvS . L <br /> MAILING ADDRESS f V �l_I� � � i,� -�-� <br /> �7 <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> L ACILITY PD # J� 7 ) -` BILLING PARTY Y I N <br /> n ' \ �J,� # OF EMPLOYEES <br /> FACILITY NAME I/L W �J' `a((n�� 120�i TRUST LANDS? Y / M <br /> FACILITY ADDRESS Sj-`�( % '�-" `�" HOME PH ( D <br /> CROSS STREET BUSH PH ( ) <br /> CITY A STATE ZIP <br /> Census --------' <br /> BOS 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 /> NAME C.: i 0 i fL A.4A P42 yet-. \C i tLN It t�LN N t HOME PHONE ( ) <br /> MAILING ADDRESS S2lFLAT NL� tL�U '12�Q6 _ BUSN PHONE <br /> CARE OF �OUCL <br /> CITY <br /> S'"IZJC.K-'��.J STATE CA ZIP ���z� <br />