Laserfiche WebLink
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 �-5 -3 CASE # BILLING PARTY Y / N <br /> OWNER NAME Wi"�-�/( C� �GI�'1 �l l '�OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH ( ) <br /> OWNER ADDRESS <br /> � fns �z�7 <br /> OWNER CITY 6/���/1-d�i�� STATE ZIP YsLFY <br /> MAILING ADDRESS <br /> CARE OF r '- w <br /> CITY STATE ZIP 3 <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # / -7 Y S BILLING PARTY Y ! N y <br /> C� # OF EMPLOYEES <br /> FACILITY NAME �j'l TRUST LANDS? Y / N <br /> FACILITY ADDRESS 5'' HOME PH ( ) <br /> CROSS STREET n iC.+ BUSH PH <br /> CITY I STATE - ZIP <br /> Census --------- BOS Dist Location Code City Code ---------- <br /> MAILING ADDRESS f'Cx APN # OL Ll I <br /> C j ll -17� V�V 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 Y <br /> NAME X Lk A—c,/,- <br /> 6 L 1 a HOME PHONE ( ) <br /> MAILING ADDRESS ck (�-� P ��� BUSH PHONE (,:5 OU-) bS I - <br /> CARE OF m11G1 �Px <br /> CITY STATE ZIP <br />