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S- . { <br /> L~ SAN J'OAQUIN Com_ Y PUBLIC HEALTH SERVICES - ENVIRONMENTAL H "_ DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH 01 15 (OWN <br /> FAC) 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 / / DE= <br /> M OWNER FILE <br /> OWNER IA Y /1 CASE iC BILLING PARTY Y / N <br /> OWNER NAME C W C, OWNER HOME PHONE (ZO } - 5,g <br /> OWNER DBA 1 • l\Ag,,rKjit OWNER WRK/BUS PH (ZC�1 b 3 _5z.94 <br /> OWNER ADDRESS �7 O �r <br /> OWNER CITY ��-F--oC��'i"4 STATE ZIP <br /> MAILING ADDRESS /1 1 I l <br /> r <br /> CARE OF 1 G <br /> CITY vTDc-K+^a f\ - -_- STATE _ ZIP <br /> i <br /> BUSINESS CODE NATURE OF OWNER BUSINESS L'. n <br />} FACILITY FILE <br /> FACILITY ID # BILLING PARTY <br /> j d-OF,EMPLOYEES <br /> FACILITY NAME R F. ►' 1 Tl Q TFt7ST LANDS? Y / N <br /> FACILITY ADDRESS r/ 4 .0 ��W. Emotl+ re - HOME PH <br /> CROSS STREET _. . !'�_`M.Q 01q. I BUSN PH <br /> CITY SAQc K+0 r'\ STATS ZIP <br /> Census --------- I BOS Dist Location Code City Code ----------- <br /> MAILING ADDRESS E + APN # <br /> CARE OF I'c-V_ r P vu/c;, I ., ._,._. SIC CODE <br /> CITY Q �+{} �f. : STATE C f ZIP <br /> GENERAL TYPE of BUSINESS at this FACILITY Fy ebi Ej c1l),Ft <br /> t DST FAC STATUS CODE BUSINESS CODE F <br /> BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION <br /> ?� NAME HOME PHONE <br />' * MAILING ADDRESS BUSN PHONE { } <br /> CARE OF I <br /> CITY STATE ZIP <br />