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G.-7-mk� <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 J /_ DELETE <br /> / OWNER FILE <br /> OWNER ID S r� 7 S� CASE # BILLING PARTY Y 1 N' <br /> OWNER NAME /�����,� OWNER ROME PHONE ( <br /> OWNER DBA �A7Y/E tAggo&E OWNER WRK/BUS PH <br /> OWNER ADDRESS <br /> OWNER CITY STATE ZIP <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # CP (/� BILLING PARTY Y / N <br /> /�/J # OF EMPLOYEES L°L' <br /> FACILITY NAME //IIIm✓'qy�/' y �/� /� TRUST LANDS? Y / N <br /> �ACILITY ADDRESS //�q ����`� HOME PH ( ) <br /> BUSH PH (2W ) �� <br /> f\p\wc CROSS STREET <br /> —� CITY q7VCef71l) STATE ZIP <br /> Census <br /> BOS Dist Location Code City Code ---------- <br /> --------- <br /> MAILING ADDRESS //7 //�-X/iJC 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 ROME PHONE ( ) <br /> MAILING ADDRESS BUSH PHONE ( ) <br /> CARE OF <br /> • STATE ZIP <br /> CITY <br />