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�, Tf:Ua EES SAP�OACUII.1 LOCAL HEALTH C)IS11'OCT tseavlHo <br /> lalp.rrl•on, Pr,• City of LOCI <br /> E. v•^^�ccl, S,c'r. 1601 Esst Hazelton4vsnue, P. O. Sox 2009 San Joaquf^Caunly <br /> city of Es"10. <br /> Stockton, Callfornla 95201 city of Maniacs <br /> n 0i%O" 209/{E��781 City of Afrion <br /> Ftnrwr J Ctly of Stockton <br /> h. Jgr;n n. m..t, f.t.0 ` '. J Clty of Trey ,- <br /> 'eMilam J. W•174 Joal Khanna, M.O.. H.P.H.. Olalrtct H■aitn Offlcar San Joaquin County r <br /> tl.rr .\nn. •., <br /> San Joaquin County <br /> RE: CALIFORNIA-LICENSED COIITRACTOR QUEST101111A1RE <br /> [t1 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 . Valinuti , Acting Oirectur, <br /> Environmental Ifealth Division <br /> BUSINESS Ni"11E 3 & F DRILL!NG CO . II4C- <br /> 8LrSI1[E55S AOOP.ESS 3663 Ortec Cr. i)6 CITY Ranclio Cordova ZIP 95742 <br /> 811S Ir1ESS TELEPHONE NUMSERS ( 1 ) 631-9546 (2 ) <br /> OW:ICR(S ) ( 1 ) greece B. Franks (2 ) <br /> 0:ll1ER(5 ) ADORESSES ( 1 ) 6830 Pecan Ave (2) ' <br /> O'•NrER(S) PRONE NOS ( 1 ) 988-6908 (2) <br /> CA. , CONTRACTOR LICENSE rlO. 51.9428 ISSUE OATE 10-15-87 EXP , OATE 10-15-90 <br /> 1.iCEtISE CLA-15IFICATiON (n ,B .C) <br /> C IF "C" INOfCATE SPECIALITY NOS . C57 <br /> lv-11 drilling (coater) <br /> 1F "C-61 " CLASSIFICAT [Ori . RIOICATE TYPE/S OF L [HITEO SPECIALITY/ IES . —_• • , -- <br /> ARE THE LICENSES LISTED AOOVE CURREMLY ACTIVE ANO 11+ G000 STAt10ING? YES X. NO _ <br /> I� <br /> IF YOU ARE SUOJECT TO WOMAAN'S COMPENSATION LAWS OF CALIFORNIA, 00 YOU CARRY <br /> WGRXMAU' S COMPENSATION INSURANCE? YES —� — no <br /> IF YES , HAVE YOU FILED A CERTIFICATE OF INSURANCE UIT11 THIS OISTRICT? YES 110 X. <br /> Ir YES , EXPIRATION OATS _.InsurgpcE: .comFLanv i -s-endirlg one._exp_ 11-1-90 — <br /> _ SIGNATURE <br /> rill [ UFF_ICi. I•lJli?11GER <br /> ,,�prf...•, ' � c•,. . c -- ,•=2].:83 . ... <br /> 'elll ell <br /> �;�, hfr\F.T <br />