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SAN JOAQUIN %,,rNTY PUBLIC HEALTH SERVICES - ENVIRONMENTAL n..OLTH 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 IDSb CASE # BILLING PARTY Y / N <br /> OWNER NAME 71-IAz A lA/ ) 44►IJAMRtJ OWNER HOME PHONE ( ) <br /> OWNER DBA OWNER WRX/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 DY / N <br /> _ # OF EMPLOYEES -� <br /> FACILITY NAME Snc�MA,� T-tl AJ�ArAAvJ ' tus r� 6r• Ate- -/'� TRUST LANDS? Y / N <br /> FACILITY ADDRESS 2211 !3 9-_A4AI�lJ 5ra8&T . -Sfgpc," �° HOME PH ) <br /> CROSS STREET F `T'2EGT BUSN ( _)�� <br /> CITY •C • FAV4, ' rOIJ STATE ZIP s <br /> Census I --------- I BOS Dist Location Code City Code ---------- <br /> MAILING ADDRESS APN # <br /> CARE OF INC, DAV10 GI'I1we�McG IJ SIC CODE <br /> CITY (4 � Qr7—jQ °/ STATE CA ZIP /5U5 <br /> GENERAL TYPE of BUSINESS at this FACILITY t/AC"-r— E.fL SrZ1/A STAT-6" <br /> UST FAC STATUS CODEBUSINESS CODE BUSINESS TYPE (UST) <br /> THIRD PARTY BILLING INFORMATION/ <br /> NAME ,t jt /J/t�LK 6� HOME PHONE (516Alrd <br /> MAILING ADDRESS �� r/rryl�i2� �1�� ( w BUSH PHONE (SIO )_ 10455 <br /> CARE OF <br /> CITYA nC' 1 GL STATE 2IP <br />