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Run by : NORA SaiTJoaquin County PHS/EHD - <br /> Report #5021 FACILITY INFORMATION as of 06/05/95 <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> Make changes/corrections in RED pen or pencil: <br /> OWNER FILE INFORMATION Date of INFORMATION CHANGE: <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 003430 New owner ID: 00 <br /> owner Name: GAMBLE, JOSEPH <br /> Owner DBA: KJAX RADIO <br /> owner Address: 110 N EL DORADO <br /> STOCKTON, CA 95202 <br /> Home Phone: 209-948-5569 <br /> Work/Business Phone: 209-948-5569 <br /> Mailing Address: 110 N EL DORADO <br /> care of: JOSEPH GAMBLE <br /> STOCKTON, CA 95202 <br /> FACILITY FILE INFORMATION <br /> FACILITY ID: 004520 <br /> Facility Name: KJAX RADIO <br /> Location: 5451 E HARDING WAY <br /> STOCKTON 95202 <br /> Phone: 209-948-5569 <br /> Mailing Address: 500 C ST S W WASH DC <br /> care of: FEDERAL EMERGENCY MGMT AGENCY <br /> S W WASHINGTON DC, VA 20472 <br /> Location Code: 01 APN: <br /> BOS District: 002 SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT ID: 0004204 New Account ID: 000 - <br /> Mail Invoices to: Account Mail Invoices to: Owner / Facility <br /> Account Name: FEDERAL EMERGENCY MGMT AGENCY <br /> Account Balance as of 06/05/95 $ .0 . 00 <br /> Record UST(s) Transfer to Activate / Inactivate. <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - -- - - - - - - - - <br /> 2381 UST FACILITY (BEFORE 1/84) PR232598 1968 YOSHIOKA INACTIVE 1 Y N A I D <br /> PUBLIC WATER SYSTEM <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 /> 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—/—/9- <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - <br /> Programs to be TRANSFERED: x - Amount Paid Date —/—/9— <br /> Payment <br /> /9_Payment Type Check. # Recvd by <br /> REHS or COUNTER SUPV: Date—/—/9— ACCT out Date_/_/9_ UNIT/File:_/_/9_ <br />