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HomeMy WebLinkAbout1729 26TH STREET'~:~z~r~r~.t~~ ~~~~~i~~~ , ~ r~ltr~~ ~.r~~+~+~~~~y °~Pt~~~~ct ~. _ ~ ~ ~._ , . Viewing/Updating Facility Information After modifying the facility information below, click 'Update Facility' to update the database. FACILITY USERS Name Phone Number Email M.in..._R_oh. 661-324-9523 m_inrohddsC.,a~yahoo_.com. M_anar...Fiaddad 661-326-3464 M_had_dad.~bak_ersfiel_dfire_._us I. IDENTIFICATION FACILITY IDN: BEGINNING DATE (MM/DD/YYYY) ENDING DATE (MM/DD/YYYy) 15 ~ ~ 021 ~~~ ~ 004013~( ~ ~~...__._._.._. ~; ~6/30/2009 ~ BUSINESS PHONE (###) k##-fttt#It BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) x###ri Min Roh , DDS _.__..._.: 661)324 9523 ' BUSINESS SITE ADDRESS: 1729 26th st. CITY: STATE: ZIP CODE: bakersfield CA 93301 DUN & BRADSTREET: SIC CODE (4 digit tt): _... .... .. . COUNTY: _....... i _.. _...f kern _ : .....................................__......................~........................_. __ BUSINESS OPERATOR NAME: ._...__. BUSINESS OPERATOR PHONE: (k#~) ##!t-k#1t# x#iIHN Min Roh ~~ ~ 661)324-9523 ~~~ II. BUSINESS OWNER OWNER NAME: OWNER PHONE: (il##) ##ri-~t#~IH x###tl Min Roh ~ ~~ uN Y~~~ (661)663-0792 ~~ ~ OWNER MAI~ING ADDRESS: 1729 26th ST. .... _... _ _...... CITY: STATE: ZIP CODE Bakersfield ~ CA '; 93301 ~ III. ENVIRONMENTAL CONTACT CONTACT NAME: CONTACT PHONE: (~#i~) #~#-#~t## x#i~## Nancy Osenbaugh __~ ____ __~ _ ' 661)324-9523~~J CONTACT MAILING ADDRESS: 1729 26th ST. cirY: STATE: ZIP CODE: https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004013 12/9/2008 rilnidocs - Uniform Documents Bakersfield j CA ; 93301 ~ IV. EMERGENCY CONTACTS -PRIMARY- -SECONDARY- NAME: NAME: Nancy Osenbaugh _~_.__ .._.,. ..._. ..._~.... . , ...__: _ ___ . _... _ _._._ TITLE: . . ___.. .~.__. _... TiTLE: Manager _ BUSINESS PHONE (##N) ##N N### x###N BUSINESS PHONE: (#N#) ~N# #Nq# x#### 661)324 9523 w j _._ 24 HOUR PHONE (##ft) N#N-It### x#N#N 24 HOUR PHONE (###) #i## ##k# xif### 661„)324 8923 _. ..~.~~~ . 661)324 9523 j _._ _.... ___ PAGER//: PAGER#: ADDITIONAL LOCALLY COLLECTED INFORMATION: Page 2 of 2 _ _ _. ~ Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certiTy under penaltyof law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. DATE: (MM/DD/Yl'W) 12/07/2008 _._ ._.~ ....._~... __,....~.. ...... ...... _~ . ..: NAME OF SIGNER Min Roh UPCF(1/99 revised) Back_to Act':vity_.Select~on. NAME OF DOCUMENT PREPARER: Min Roh _..~......... _._...._._.~~ _...__.._ ._.....~ ~.... ....._. TITLE OF SIGNER. owner OES FORM 2730 (1 /99) home ~ whaYs ~ew ~ membe.rs._agencis.s ~ docu.ments._a.n. d services ~ se...ar.c..h unido, cs ~ c...o.~#ac.t._u.s. related._links ~ tra..inmg a.n...d. meetin.gs For comments or questions regarding the HMIS project, contact the .pnline. D~t.~p.~$e._Admi_ni.strat.pt. ~~/~n vo / ~ J~ ~ ,.... ~'~~ / '~. ~-f p. y~ _ ._--_. ~o~~ 9~ ~ o-~ ~.~ Z• ~-- _ 46 -- ~~' -- ~-- ~'''~• S. ~• hosted by Citv af Palo Alto https://unidocs.ecointeractive.com/user/facility edit.asp?facility id=15-021-004013 12/9/2008