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nr n ..n.. <br /> FROM OGISO 5104515771 06-10-99 03:06PM TO 19163645633 x182 P.2/5 <br /> I ' <br /> I <br /> CONTRACTOR/CONSULTANT QUESTIONNAIRE <br /> PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> I ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 STOCKTON CA 95201-0388 <br /> OWNER INFORMATION <br /> D5 9 NAME: ! <br /> 1 OGISO Environmental <br /> DRE$$: 1504 Franklin St. Ste. 304 <br /> CITY/ TATE/ZIP: Oakland , CA 94612 <br /> PHQNB NO ( 510) 451-5771 PHONE NO 2 ( 510) 451 -5772 PAX NO (510) 451 -5773 <br /> PtMW t{1 INFORMATION OWNER #2 INFORMATIOV <br /> Dr . Clement I . Okoh NAME <br /> I <br /> I <br /> DREIS: 1504 Franklin St. Ste. 304 DRESS: <br /> I <br /> ITY: j Oakland CITY: <br /> III <br /> ATBeI CA ZIP: 94612 STATE: <br /> ZIP: <br /> LICENSE INFORMATION <br /> CONTRACTOR LICENSE AOHA?2 DATE ISSUED 5 / 9 /95 MP DATS5 / 31/ 199 <br /> "'C'aCLASS 1 LICENSE CLASS 2 LICENSE CLASS 3 <br /> VC. <br /> a CLALITY #'8 <br /> 88 F LIMITED SPECIALTY(IES) <br /> ICSN n; GOOD STANDING? O N WORMS COMP INSMtANCE � N <br /> COMP 'N8URANCE CERTIFICATION ON FILE WITH E.H.D. ? Y <br /> ERBIRATION DATE / A <br /> US WASTE ZT::7] <br /> IIP CERTIFICATION? Y N <br /> SGFIRMiNFOgMATIONITE M TIGATION IRM? Y N SAMPLIMIG FIRM ONLY? Y x <br /> CA REGISTERED OR CERTIFIED GEOLOGIST/E?GINEER? �, <br /> N <br /> PRIMAR QUALIFYING INDIVIDUAL: (vary p, tlaccKj 6,1 <br /> Ca ( I-Pornro lieyisf•eted 6ectoo /S (00'/G <br />