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SAN 70AQUIN COUNTY PUBLIC HEAL'T'H SERVICES - ENVIRONMENTAL HEALTH "VISION <br />01 15 (OWNFAC) Revis 8/26/93 <br />MASTERFILE RECORD INFORMATION FORM EH <br />CHANGE OF OWNER DATE OF OWNER CHANGE / <br />/ INACTIVE <br />NEW FACILITY <br />Prior Owner <br />CHANGE OF BILLING DATE OF BILLING CHANGE / <br />DELETE <br />UNDER CONSTRUCTION <br />OWNER FILE <br />BILLING PARTY Y / N <br />OWNERID� <br />OWNER HOME PHONE ( ) <br />OWNER NAME <br />OWNER WRK/BUS PH ( ) <br />OWNER DBA <br />OWNER ADDRESS -2')44 3'Z (w 1 <br />S- t"- -- STATE _ ZIP 2-OG <br />CITY �V� <br />MAILING ADDRESS <br />CARE OF <br />STATE ZIP <br />CITY <br />BUSINESS CODE NATURE OF OWNER BUSINESS <br />FACILITY FILE <br />Xn BILLING PARTY Y <br />FACILITY ID # � � CJ <br /># OF EMPLOYEES <br />i \( )CN Rem lav TRUST LANDS? Y / N <br />FACILITY NAME <br />Y�HOME PH ( ) - <br />FACILITY ADDRESS � 7 •' l � . <br />CROSS STREET <br />CITY Qkzl c-L-sv, <br />Census I --------- I BOS Dist <br />BUSN PH ( ) - <br />STATE C-,,6, ZIP ( S 3-0(0 <br />Location Code I I City Code I ----- <br />,f S d .iT2-� APN # <br />MAILING ADDRESS � / <br />V� <br />SIC CODE <br />CARE OF <br />CITY S�O •� STATE <br />Lf� ZIP a Sr 7�Co <br />GENERAL TYPE of BUSINESS at this FACILITY <br />UST FAC STATUS CODE <br />THIRD PARTY BILLING INFORMATION <br />--:0 G,� 4�� <br />BUSINESS CODE <br />BUSINESS TYPE (UST) <br />1 <br />HOME PHONE <br />C'� T tI SI IPHONE ( 240 <br />MAILING ADDRESS . <br />CARE OF — <br />