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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pres. SERVING <br /> Patricia E. Vannuccl, Secy. City of Lodi <br /> Tommy Joyce 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Bu9beoc <br /> el <br /> Fbe <br /> Fern e Stockton, California 95201 City of Escalon <br /> Daniell <br /> DL. City of Manteca <br /> Flores 209/466-6761 City of Ripon <br /> John D.. Mast, M.D. City of Stockton <br /> William J. Wade Jopl Khanna, M.D., M.P.H., District Health Officer City of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <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 below. Please answer all of the questions <br /> and return the original of this letter in the self-addressed envelope provided. <br /> Ron L. Valinoti , Acting Director <br /> Environmental Health Division <br /> BUSINESS NAME American Environmental Mana ement Corporation <br /> BUSINESS ADDRESS 11855 White Rock Rd. CITY Rancho Cordova, Ca. ZIP 95670 <br /> BUSINESS TELEPHONE NUMBERS (1) _(916) 985-6666 (2) <br /> OWNER(S) (1) Bank of America (2) <br /> OWNER(S) ADDRESSES (1) Oak Street <br /> (2) Lodi, California <br /> OWNER(S) PHONE NOS ( 1) (2) <br /> CA. , CONTRACTOR LICENSE NO. 464159 ISSUE DATE 10-31-87 EXP. DATE 10-31-88 <br /> LICENSE CLASSIFICATION (A,B,C) A 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? YES X NO <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, 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 />