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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pros. City of Lodi <br /> Patricia E. Vennucci, Secy. 1801 E1131 Hazelton Avenue, P. O. Boz 2009 Sen Joaquin County <br /> Tommy Joyce City of Escalon <br /> Earl Pimentet Stockton, California 95201 City of Manteca <br /> Fern aupbee 209/488 6781 City of Rlpon <br /> Daniel L. Flores City of Stockton <br /> John D. Mast, M.D. City of Tracy <br /> William J. Wade Jogi Khanna, M.D., M.P.N., District Health Officer San Joaquin County <br /> Mary Anne Love San Joaquin County <br /> al E9 <br /> . APR 19 1989 <br /> Ei' ,/:,;,)?1F.7 NTA_ HEALTH <br /> PERMIT/SERVICES <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE <br /> In order to comply with State and Local Laws relative to contractor licensing and <br /> Workman's Compensation Insurance requirements, we are asking that you provide this <br /> District with the information requested_ pelow. Please answer all of the questions <br /> and return the original of this letter in the self-addressed envelope provided. <br /> [ton L. Valinoti , Director <br /> Environmental Health Division <br /> BUSINESS NAME RYAN-MURPHY INC . it <br /> BUSINESS ADDRESS 211 GRANITE ST CITY CORONA ZIP 91719 <br /> BUSINESS TELEPHONE NUMBERS ( 1 ) (714) 279-6210 (2) <br /> OWNER(S) ( 1 ) (2) <br /> OWNER(S) ADDRESSES ( 1) (2) <br /> OWNER(S) PHONE NOS ( 1) (2) <br /> CA. , CONTRACTOR LICENSE NO. 516337 ISSUE DATE EXP. DATE <br /> LICENSE CLASSIFICATION (A,B,C) A & B IF "C" INDICATE SPECIALITY NOS. 61 <br /> IF "C-61 " CLASSIFICATION, INDICATE TYPE/� OED SPECIALITY/ IES. �{ST_�snoew � <br /> 'STP [fPM&ri Q <br /> f SSOG 1{/t° 1J _ _ <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY AVEC VAND IN GOOD STANDING? YES NO <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAI- IFORNIA, DO YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES x NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES _NO _ <br /> IF YES , EXPIRATION DATE <br /> SIGNATURE / <br /> TITLE _ <br /> DATE <br />