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MA' K FILE RECORD INFORMATION HM <br /> SWEtrS <br /> ^C'brL Cosnt r P r o g/Sub E l e m COr PAW No. t.,v <br /> 3 I <br /> E . H . (assigned by clerk) <br /> P/S . E . Local Com . Number Su Dist . Location CodeFee Ex. <br /> L A ( o , I Il <br /> l� <br /> Previous Comp. NuMoEn T Effective oate Other Program Activity <br /> L I I-TT I I I <br /> SITE NAME (00 chwactora) _ <br /> SITE Address (no./Vir/Street/Suffix/Suite) Site City/State/Zi <br /> PREVIOUS DBA <br /> Bi 11 i nq dame _ <br /> I <br /> Billing .address (Ho/Dir/Street/Suffix/Suite) Bi111n2' City/State/Zip <br /> Est SJZE / <br /> ate <br /> �p SJTE TELENKM Mlls.4GER <br /> / a a NCA_—t <br /> IF <br /> FT I <br /> Sq Un t <br /> Il <br /> OWNER N/utE (00 chwacw3) . <br /> OWNER Address (No ./Dir/Street/Suffix/Suite) Nner City/State/Zip <br /> F- <br /> SPECIAL PROGRAM I14FOR!IATI ON No.of S•rvlCI Source of Treatment Population <br /> Connections Supply Type Served <br /> Rec. Heal th a ter L I I - J <br /> hLJ <br /> ADDITIONAL C0MMENTS : NN Ci.,( 7 C-%1 /3L4S / Nes <br /> L S Jll n C .7 I l,' /9 7C'� ----- <br /> San. Sup. AC Sf� <br /> EH 01 15 <br />