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! <br />! SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL HEALTH DIVISION <br /> MASTERFILE RECORD INFORMATION FORM EH Ol 15 (OWNFAC) Revis 8/26/93 <br /> NEW FACILITY CHANGE OF OWNER DATE OF OWNER CHANGE / / INACTIVE <br /> Prior Owner <br /> E UNDER CONSTRUCTION CHANGE OF BILLING DATE OF BILLING CHANGE / / DELETE <br /> OWNER FILE <br /> OWNER ID CASE # BILLING PARTY Y / N <br /> F <br /> OWNER NAME <br /> OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRK/BUS PH ( ) <br /> OWNER ADDRESS <br /> OWNER CITY STATE ZIP <br /> MAILING ADDRESS <br /> CARE OF <br /> CITY STATE ZIP <br /> BUSINESS CODE NATURE OF OWNER BUSINESS <br /> FACILITY FILE <br /> FACILITY ID # BILLING PARTY Y / N <br /> #.OF EMPLOYEES <br /> FACILITY NAME TRUST LANDS? Y / N <br /> FACILITY ADDRESS HOME PH ( ) R <br /> CROSS STREET BUSN PH ( ) <br /> 4 <br /> CITY STATE 1/f ' ZIP <br /> I <br /> Census --------- SOS Dist Location Code City Code ----------- <br /> i <br /> MAILING ADDRESS APN # 1 <br /> f <br /> CARE OF SIC CODE f <br /> CITY STATE ZIP <br /> 4 <br /> GENERAL TYPE of BUSINESS at this FACILITY ! <br /> t <br /> UST FAC STATUS CODE BUSINESS CODE7- <br /> BUSINESS TYPE (UST) I <br /> THIRD PARTY BILLING_INFORMATION �I _ C�--cT ����-� w��� •P Vry^�yt� <br /> NAME A 1 V/hSlilnn �-�f�t��.��1 C�l �rC ni _ `0. HOME PHONE ( ) <br />' MAILING ADDRESS d� I `� w ' 7"'(`ZP,-Q,i BUSN PHONE ( 1 <br /> CARE OF <br /> ZIP S31 <br /> STATE <br /> CITY ' ` `�-lJ <br /> i <br />