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Run by : NORA Sari Joaquin County PHS/EHD 1 Report #5021 <br /> FACILITY INFORMATION as of 08/29/96 <br /> - - - - - - - - - - <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION INFORMATION CHANGE (date): <br /> OWNERSHIP CHANGE (date): <br /> OWNER ID: 005721 New Owner ID: 00 <br /> Owner Name: KJAX RADIO STATION (FEMA) <br /> Owner DBA: <br /> j Owner Address: 110 N EL DORADO ST <br /> 1i STOCKTON, CA 95201 <br /> Home Phone: <br /> Soc Sec# / Tax ID#: <br /> Ownership Type: 01 CORPORATION <br /> Mailing Address: 110 N EL DORADO ST <br /> Care of: ALAN GRAFT, CHIEF ENGINEER <br /> r STOCKTON, CA 95201 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 006961 <br /> Facility Name: KJAX <br /> Location: 5451 E HARDING WAY <br /> STOCKTON 95202 <br /> Phone: <br /> Mai}ing Address: H T [n( 1 Ck O('c1fLlS <br /> of: ALAN-.GRA-Fr� nIEF—ENGINEER <br /> ssocKTON;-eA 9s-Zar— oo 1'�r S o <br /> OAb <br /> Lo tion code: 99 APN: <br /> BOS District: 002 SIC Code: - <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0009915 New Account ID: 000 <br /> ( Mail Invoices to: Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name: KJAX RADIO STATION (FEMA) (Circle one) <br /> Account Balance as of 08/29/96: $351. 00 (Circle one) <br /> Record UST(s) Transfer to Activate / inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ <br /> 2951 UGT•CAP PR505722 0001 TURKATTE ACTIVE Y N A I D <br /> _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or <br /> ( project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> II BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> +i _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ <br /> I PR Records to be TRANSFERED: x $20.00 = Amount Paid Date—/—/— <br /> Water <br /> ate_/ /Water System to be TRANSFERED: x $150.00 = Amount Paid Date—/—/— <br /> Payment <br /> ate_/ /Payment Type Check # Recvd by <br /> REHS or COUNTER SUPV: Date/ / ACCT out: Date /ZT / UNIT/File:_/_ <br /> i <br />