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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbertson, Pree. <br /> Patricia E. Vannuccl, Sec'y. City of Lodi <br /> Tommy Joyce <br /> 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County <br /> Earl Plmentel Stockton, California 95201 City Es talon <br /> Fern Bugbee y ot <br /> Daniel L. Flores 209/466.6781 City of Ripon <br /> Cally of Stockton <br /> John Mast, M.D. City of Tracy <br /> Williamm J. Wade Jogl Khanna, M.D., M.P.H., District Health Officer San Joaquin County <br /> Mary Anna Love 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 Corp. <br /> BUSINESS ADDRESS 9719 Lincoln Village DreffV Sacramento ZIP 95827 <br /> BUSINESS TELEPHONE NUMBERS (1) (916) 364-8872 (2) (916) 985-6666 <br /> OWNER(S) (1) CR&R, Inc. (2) <br /> OWNER(S) ADDRESSES (1) 11292 Western Ave. (2) Stanton, CA 90680 <br /> OWNER(S) PHONE NOS (1) (714) 826-6320 (2) <br /> CA. , CONTRACTOR LICENSE NO. 464159 ISSUE DATE 10-23-84 EXP. DATE 10-31-90 <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 NO <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES xx NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES xx NO_ <br /> IF YES, EXPIRATION DATE January 1, 1991 <br /> SIGNATUR <br /> TITLE r E <br /> DATE January 25, 1990 <br />