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f <br /> SAN JOAQUIN y PUBLIC HEALTH SERVICES - EHVIROINTALTB-DIVISION r <br /> MASTERFILE RECORD INFORMATION FORM x-' T <br /> EA 01 15 (OWNFAC) Revis 8/26/93 <br /> NEW FACILITY /t CFD�NGE OF OWNER �r "' <br /> DATE OF OWNER CHANGE x/` ' / 1=CTIVE <br /> 1 <br /> ' _ .Friar Owner + <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATfi OF BILLING CHANGE / / DELETE <br /> i <br /> . :UWNER FTLE r_ <br /> FOWNER ID ' CASE # ' HILI,ING PARTY Y <br /> OWNER NAME i`�p1w TrQCi �p fk Sl�( *F OWN£R HOt 'PHONE <br /> OWNER nHA ZA 9 <br /> "OWNER ADDRESS <br /> •�e.�1�1 lO,r�v�^"` �.:�,�2..;":�. ,- , �,'" S�` ��. `�a t :xnr.7. r <br /> OWNER CITY SC.LT.+1 C► ZIP52tg <br /> RECEIVED <br /> MAILING ADDRESS J4�M9.. 9 . <br /> P R 51996 a <br /> ,. <br /> r L• =KI.VIRONMENTAL HEALTH <br /> 'PERMIT./SERVICESY �f <br /> t z STATE ZIP k <br /> BUSINESS CODE NATURE`OF OWNER.BUSINESS <br /> a y f c FACIL= FILE <br /> . ... . d•'.'fit' [s ;"�i. :Jr;. "° y <br /> FACILITY / N i <br /> # r : j� BILLING PARTY, Y €:< <br /> r ' <br /> by _ !. - \ '! - ,k i M - - !� A 4 Y - '.•• 1 <br /> OF EMPLOYEES <br /> .FACILITY.NAME <br /> TROST LANDS? Y / N <br /> �•.. r <br /> FACILITY <br /> ADDRESS :TrR �.]tili►+�Jnl�. `�x ROM PH <br /> 3 - CROSS STREET 4 O r V Rte ' ¢ 4r s ` HIISN PH <br /> s. <br /> r <br /> n <br /> ��/'QSXV <br /> 7=. <br /> �:`. lip <br /> Census t» _HOS'Dist __ <br /> 4 } Location Code 'r Caty-'Code <br /> ���� g J r.- �k f - � t.�G., _ �k. t x F �.�' '�••, x r+aV`9r^,a� <br /> MAILING .ADDRESS Sd AJO� <br /> r j voZ G' � P k.-<-3• r` h i 1 1i Y 4as 3" ' f - } F.'{ � E - <br /> (CARE OFA 1 ti � w t° � 3 SIC CODE <br /> t•� ? s aTyyie f ' - <br /> xy ° y l °T ', rGEJNSRAL TYPE of.BUSINESS 8C this P1►CII.ZYY MI VQ& <br /> >, a.� r' r <br /> �S�'Fl.0 STATUS CODE. t rr r r r BQSIPIESS'CODE' y BUSINESS5 <br /> T$IRD�ARTYEILLING+INFORMATI <br /> ��nn•`r.. t � <br /> 'I.1�: tr. ,W 1 1� - �/-ti"�4.7\C�.�S LCL+` Fl r= � ,�t l�.� Q?`-4 �]Q�� <br /> HOME PHONE ( 1 <br /> Marf:nae•,nnaREss h/1aA_SoA- '.=10-SZ nBUSK gxoNe [ 2t3 , fQl 5340 <br /> r a. <br /> CARE OF <br /> r <br /> CITY tom? 'r SLATE... ZIP 9 1 ti' ' <br />