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�3 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH O1 15 (OWNFAC) Revis 8/26/93 <br /> NEW FACILITY <br /> CHANGE OF OWNER DATE OF OWNER CHANGE / / INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION <br /> CHANGE OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> OWNER FILE <br /> OWNER ID 1 I �I CASE # BILLING PARTY Y / N <br /> OWNER NAME 1 t � OWNER HOME PHONE ( ) <br /> OWNER WRK/BUS PH ( ) - <br /> OWNER DBA <br /> OWNER ADDRESS <br /> OWNER CITY <br /> STATE ZI�` <br /> MAILING ADDRESS c <br /> �s 1 � <br /> CARE OF <br /> CITYi/1 u/ STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY E: Y / N <br /> �L # OF EMPLOYEES <br /> `"� TRUST LANDS? Y / N <br /> FACILITY NAME t/y, <br /> FACILITY ADDRESS \ t I " ` F HOME PH <br /> BUSN PH <br /> CROSS STREET <br /> CITY <br /> STATE �,/ ` ZIP <br /> Census --------- <br /> ]::BOS Dist Location Code City Code ----------- <br /> MAILING ADDRESS COO �' '�' " �'"� APN # <br /> SIC CODE <br /> CARE OF <br /> CITY Nl�\ I� ✓�/�� �(L- STATE �\ ZIP —�� <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE <br /> �BUSINESSDE BUSINESS TYPE (QST) <br /> THIRD PARTY BILLING INFORMATION <br /> NAME C HOME PHONE ( ) <br /> MAILING ADDRESS ` ' s,1L��-', C� L BUSN PHONE <br /> CARE OF <br />