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4-23-1997 2:42PM FROM P, 3 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM ER 01 15 COWNFAC) Revis Sf%n3 <br /> XV FACILITY CHANGE OF WNER DATE OF OMER CHANCE _ / / INACTIVE <br /> Prior Oww <br /> WER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANCE 1 / DELETE <br /> OWNER FILE <br /> QUER TD CASE B BILLING PARTY Y / O <br /> k� I -�^ <br /> OWNER NAME 0.r ail!I I L h G• _ OWNER RCAF PHONE C ) <br /> OWNER DBA C a C �� M o(Q,5��-G _L_I g Iv j;k Pr A Dt,nle kOWNER i1RlC/8US PH CZoo ,) "Q � <br /> ADDRESS 2 we°;+ Wo,ski-tr4f-eri_AU� n <br /> CITY Sf-oQkton STATE CA ZIP <br /> HAILING ADDRESS S0.v�ne 0.L aloaVe <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS 000E NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> 1FACStITY ID S BILLING PARTY Y / <br /> I L S OF EMPLOYEES pr <br /> FACILITY NAME CAV'G1 e �I M O lat S S E t-�<- oPr.A fr'I ��I VI S(0✓t TRUST WINDS? Y / H N <br /> FACILITY A06RF-SSPH <br /> 21.3_D I/UCS1 ��GtL�Ivia�O(n AVS• HONE ( ) <br /> CROSS STREET Pov f emk 2 ! BUSH PH (Z-OR _) <br /> CITY J T OC.K T O VL STATE ZIP /s 2-0s <br /> Census - -- BOS Dist Location Code= <br /> ode City CO& ---•-----•- <br /> MAttING ADDRESS Sa►A�e AS GZ !J©V�; APH S <br /> CARE Of StC CODE <br /> CITY STATE ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> USi FAC STATUS COOE BUSINESS CODE BUSINESS TYPE CUST) <br /> THIRD PARTY BILLTNG, e INFORMATION / f 'jam <br /> NAME If,,rig /IirOVIWtE+uTa I �VI5,0�I .J t. HONE PHONE ( ) <br /> MAILING ADDRESS.�a1 bT ' G619 �t�„�tit 4�1 �h_ _ QWk!o (-4Cjr AVn pC/"/l-�n SuSN PHONE ( ) R JJ <br /> rARF Of /'!)car. y0A <br />