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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) Revis 8/26/93 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWNER CHANGE /_ INACTIVE <br /> Prior Owner <br /> UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE / /_ DELETE <br /> OWNER FILE <br /> OWNER ID �'� �D , 1 C1 (� CASE # BILLING PARTY Y / N <br /> OWNER NAME .d Cell V D 6'( I 4n D/1 ,c AJJ OWNER ROME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH C_)_-_ <br /> OWNER ADDRESS <br /> 06�- <br /> OWNER CITY STATE ZIP <br /> P � �` b tea 1a � <br /> MAILING ADDRESS � O Iv M <br /> CARE OF <br /> CITY EI;:}y A.(: �. STATE <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> h ,� / FACILITY FILE <br /> FACILITY ID # © �'V l� Yf BILLING PARTY Y / t! <br /> # OF EMPLOYEES <br /> FACILITY NAME TRUST LANDS? Y / N <br /> FACILITY ADDRESS ay1J C-��7`f_\t i�\, K-CA HOME PH ( ) <br /> CROSS STREET �XY/V'"(�v�.�-�' BUSH PH ( ) <br /> CITY I STATE �"N"� ZIP 1 l 40 <br /> Census�J --------- I BOS Dist Location Code City Code ---------- <br /> MAILING ADDRESS f O I n/. w APN # 5- 0-7 U Y <br /> CARE OF <s2N-��(�+�n-p� � � SIC CODE <br /> CITY 5�C y��T U'"� STATE C-A ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION �} <br /> NAME L_ �7'+'�p�0 HOME PHONE <br /> L <br /> MAILING ADDRESS <��/ SD/ln 6L✓f% SE:CC �� BUSH PHONE <br /> CARE OFJn=�T��Ylgal, �{�/1d L L�4 <br /> CITY YInQl^"a STATE O-A ZIP <br /> as' (� <br />