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SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> SOARO OF TRUSTEES City o(Lodl <br /> James Culbertso(1. Pres. San Joaquin County <br /> Pstrlcta E. vannucV. Sac'y. 1601 East Hazelton Avenue. P. 0. Box 2C09 City of Escalon <br /> Tommy JoyceCity of Mantaca <br /> +rt Plmantal Stockton, Calllo rnla 9520t City of Ripon <br /> .-ern Sugt)" _ 2G9/466-6781 City of Stockton <br /> "Daniel L. Flares City of Tracy <br /> Jcnn 0. Mast. M.O. San Joaquin County <br /> William J. Wade JaQI KTanna, M.O.. M.P.H., Olatrfci He+ItR Offle sr San Joaquin County <br /> Mary Anna Love <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 askinc that you provide this <br /> District with the inro nation requested below. Please answer all of the questions <br /> and return the original o`* this letter in the self-addressed envelope provided. <br /> Ron L . t7a1inot4 , Actino Director <br /> Environmental Health Division <br /> BUSINESS NAME American Enviromental Management Corporation <br /> BUSINESS ADDRESS 9719 Lincoln VillaSeDrCITY Sacramento ZIP 95827 <br /> BUSINESS TELEPHONE NUMBERS ( 1) (916)364-8872 (2 ) 985-6666 <br /> OWNEO(S) ( 1) C.R. & R Inc. (2) <br /> OWNER S) ADDRESSES ( 1) 11292 Western Ave (2) Stancon, CA 96680 <br /> OWNER(S) PHONE NOS ( 1) (714)826-6320 (2) <br /> CA. , CONTRACTOR LICENSE NO. 464159 ISSUE DATE 10-23-84 EXP. DATE 10-31-89 <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 /> �- <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN 0000 STANDING? YES X NO_ <br /> IF YOU ARE SUBJECT TO WORKMAN'S COM ATION LAWS OF CALIFORNIA, 00 YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES <br /> IF YES , HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES X NO_ <br /> IF YES , EXPIRATION DATE January 1, 1990 <br /> SIGNATURE <br /> TITLERegionalManager-En ineerin . <br /> 0ATE September 30, 1988 <br />