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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWNFAC) Revis 5/14/93 <br /> NEW FACILITYCHANGE OF OWNER DATE OF OWNER CHANGE / /_ INACTIVE <br /> - - Prior Owner -- <br /> UNDER CONSTRUCTION CHANCE OF BILLING "� DATE OF BILLING CHANGE / ._ DELETE ' <br /> CAER FILE - <br /> OWNER 10 CASE # BILLING PARTY Y / N <br /> OWNER NAME "_(�M C , -Ull� OWNER HOME PHONE <br /> OWNER DBA OWNER WRK/BUS PH ( ) <br /> ADDRESS .. _ <br /> CITY �n ':'.STATE ZIP - <br /> MAILINGADDRESS <br /> CARE OF <br /> CITY S—1 7� 'LSTATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE - <br /> FACILITY IDX rl/\ L� 1 � C BILLING PARIT <br /> U <br /> v /� ;,4 •" - # OF EMPLOYEES <br /> FACILITY NAME ..,_.D.V�/�"� _ {'"✓/,�1,1,�1�Lh"'L.. 'y/�� J4 __ TRUST LANDS? Y / N <br /> FACILITY ADDRESS C� C� `' \ ' \nA-:�:��Y'1'�-��✓1 i�-VI HOME PH ( ) <br /> CROSS STREET .. BUSH PH <br /> CITY STATE �� 1 ZIP <br /> Loaatlan Cade City Code <br /> _ <br /> NAILING ADDRESS i APR # <br /> - <br /> CARE OF .1'✓��� ... ` i. lQ � SIC CODE <br /> -. <br /> CITY �� T'i STATE '' Yom" ZIP <br /> —GENERAL TYPE of BUSINESS at this FACILITY <br /> UST FAC STATUS CODE BUSINESS CODE - BUSINESS TYPE (UST) - <br /> THIRD PARTY BIL�LIN/GG INFORMATION - - - - <br /> NAME / •�j Y\Q � L�iJpl..�(J,, HCME PHONE <br /> MAILING ADDRESS '7�1D �n - `Ij �/Y�N_�__B-`/l IT�RiLtx BUSH PHONE (c5 LU)QD4.J <br /> CARE OF <br /> CITY ��� .STATE ` ZIP l <br />