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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL H TH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OUNFAC) Revis 5/14/93 <br /> F� <br /> NEW FACILITY Le 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 PARIY / N <br /> OWNER NAME J 7 , /�j�G�/�`l.¢�t OWNER HOME PHONE ( 3 tJ <br /> 7-,kw,A/Avv f Ac Guf�ic� <br /> _WNry S'7 EL <br /> ER DBA r � u�y OWNER WRK/BUS PH { ) <br /> ADDRESS <br /> r1-TY—J3momv-� Y -�STATE- <br /> 0 Aj/j <br /> TATESoAj.j C5 DDR // EJi4K/r/ld rr7- IJ/i'1y� `��o y <br /> MAILING ADDRESS //����(D <br /> CARE OF /'F/PJ1�7Pr <br /> CITY ��il�`>QI��i�t STATE Grr ZIP <br /> BUSINESS CODE NATURE OF-OWHID[t BUSENE55 <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / <br /> ;reAj,4A r- # OF EMPLOYEES UN D 1✓ <br /> Jht"tAwNAME � � �!/rf ��� � TRUST LANDS? Y / <br /> FACILITY ADDRESS ©D 0 - HOME PH ( ) �[Q <br /> CROSS STREET �7 L�IJ C���� BUSH PH (,fdq �!C/ - <br /> CITY STATE ZIP <br /> =Census.. ---_-_-- =SOS Dist ►r-- �Lccation`Cede= — :CIzy`Code ----------- <br /> MAILING <br /> --------_ <br /> MAILING ADDRESS AILI�f '�� `' APH A 119 —/Qo —z) <br /> CARE OF /'"�� r 1'G�f SIC CODE <br /> CITY STATECr--- ZIP 9SZDS �T Z� <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> 1e THIRD PARTY BILLING INFORMATION <br /> NAME HOME PHONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF <br /> CITY STATE ZIP <br />