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BOARD OF TRUSTEES <br />James Culbertson, Pres, <br />Patfkla E. Vannuccl, Secy <br />Tommy Joyce <br />Earl Pimentel <br />Fern Bupbes <br />Daniel L. Flores <br />John D. Most, M.D. <br />William J. Wads <br />Mary Anna Love <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 East Hazelton Avenue, P. 0. Box 2009 <br />Stockton, California 95201 <br />2%/466-6781 <br />Jopl Khanna, M.D., M.P.N., District Health Offlcer <br />AUG 1 1988 <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES, <br />RE: CALIFORNIA -LICENSED CONTRACTOR QUESTIONNAIRE <br />SERVING <br />City of Lodi <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City of Stockton <br />City of Tracy <br />San Joaquin County <br />San Joaquin County <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 below. Please answer all of the questions <br />and return the original of this letter in the self-addressed envelope provided. <br />BUSINESS NAME <br />Kon L. Valinoti, Director <br />Environmental health Division <br />C <br />BUSINESS ADDRESS, ,%� j3 1, CITY 211AC rx ZIP ,'G G'�6 <br />BUS INESS TELEPHONE NUMBERS (1) (y/�%S� i- SUi (2) (916) 527-5085 <br />OWNER(S) (1) (2) SUE-COTITRACTOR: Rich Lehman <br />OWNER(S) ADDRESSES (1) (2) P -0 -Box 1239, Red B1uff,CA 960&0-- <br />OWNER(S) <br />0 0OWNER(S) PHONE NOS (1) (2) LIC . #1+116552 - Class A <br />CA.. CONTRACTOR LICENSE N0. �7�� ISSUE DATE _ EXP. DATE- <br />LICENSE CLASSIFICATION (A,B,C) — IF "C" INDICATE SPECIALITY NOS. <br />IF "C-61" CLASSIFICATION, INDICATE TYPE/S OF LIMITED SPECIALITY/IES. <br />ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING? YESX-NO <br />IF YOU ARE SUBJECT TO WORKMAN'S CO ATION LAWS OF CALIFORNIA, DO YOU CARRY <br />WORKMAN'S COMPENSATION INSURANCE? _ NO _ <br />IF YES HAVE YOU FI ED <br />SIGNATURE <br />TITLE <br />DATE- <br />L A CERTIFICATE F INSURANCE WITH THIS DISTRICT? YES NO /y�,f'i6.�fr1 <br />IF YES, EXPIRATION DATE _;� l <br />--- <br />