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TER FILE RECORD INFORMATIt ORM <br /> StrcEPS <br /> cIn County P r o g/Sub E l e m Computes No. <br /> ^ ') <br /> 3 � LZIZIZ-5� ,7T7 36IZ I <br /> E .H . `assigned by clerk) <br /> P�/S . E . Local Com . Number Su Dist . Location CodeFee Ex. <br /> c l � 3 0 13 1 :ZE0 <br /> � <br /> Previous Comp. NuMo[R Effective oste Other Program Activity <br /> z -1 -T <br /> SITE NAME (30 chwactwa) <br /> SITE Address (no./Pir/Street/Suffix/Suite) Site City/State/Zi <br /> 5• S: Izdi A 524C) <br /> ePPr-41: Cicoo 0(0303CQ��(o <br /> PREVIOUS DDA <br /> ei l l i a JlAme _I <br /> 1 <br /> Billing Address (No/Dir/Street/Suffix/Suite) Qilliny' City/State/Zip <br /> ESI aIzE SJTE TEUNsCw:E"40EH <br /> 1 SCatS <br /> Sq.nF�� Z <br /> gut <br /> OWNER KAsAE(30 CtW3C 3) . <br /> OWNER Address (14o./Dir/Street/Suffix/Suite) Owner City/State/Zip <br /> SPECIAL PROGRAM INFOR-MATION No.of$+roles Source of Treatment Population <br /> Connecil ons supply Type Served <br /> Ric. Ileal th Lwae_ <br /> rj <br /> ADDITIONAL COMMENTS : <br /> San. Sup. AC SC <br /> EIl 01 15 gr 0 F <br />