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/ <br /> SAN JOAQU' iNTT PUBLIC HEALTH SERVICES - ENVIRORKENTAL TH DIVISICH <br /> MASTERFILE RECORD INFORMATION FORM EN 01 15 (OWNFAC) Bevis 5/16/93 <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 IO CASE # BILLING PARTY Y / N <br /> OWNER NAME PHC 11'I G GF}S .LLL- CrKI y OWNER HANE PHONE ( ) <br /> OWNER 08A C. OWER WRz/BUS PH ( ) <br /> ADDRESS I3O x 7640 <br /> CITY SHNf7kONC Is 1) STATE �A ZIP L/4 1`1.c) <br /> MAILING ADDRESS S�Y>7C <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS C / A S 1 TG <br /> FACILITY FILE <br /> FACILITY ID BILLING PARTY T / N <br /> {� �1 f OF EMPLOYEES <br /> /� <br /> FACILITY NAME / °� mc a 0pl 14LD 16b"D LAP l� X1S,?0,ShfPA T LANDS? T / N <br /> MM''� /� nn 5 I TC <br /> FACILITY ADDRESS I)Z'16Q1VA"L1) ISA/fiNU - K-5L _ 7 ,9 ,14 /'1']Q/3rI HOME PH ( ) <br /> CROSS STREET /rU L 7 BUSH PH ( ) <br /> CITY 51 0 CK TO STATE C4 ZIP <br /> Census --------- 30S Dist Location Cade City Code ---------- <br /> MAILING ADDRESS P . o / D X 74+0 AN $ <br /> CARE OF )p(, Sic CODE <br /> CITY C I S D STAIEi�, ZIP c/4 6�� <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CSE BUSINESS TYPE (UST) <br /> THIRD DARTY 3ILLING TNFORMATTON <br /> NAME HCME PHCNE <br /> 4AILiNG ADDRESS BUSH PHONE C ) <br /> CARE OF <br /> CITY STATE ZIP <br />