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APR-09-2001 13=54 FROM PRECISION SAMPLING TO 12094640138 P.02 <br /> IrAk <br /> ,' . . '� ay°R• 7•r . F.' j <br /> 111 ' f <br /> e .r_:e- .nom Y'• :'1 '',.ccc,'lri^r:ti/•�./3� �► jy}y� �/a.Z ��p� �T -`., (,�. a/3'►.{_'r�F� ..« <br /> 1 haaby a ffi, OW 1 am&*nmd under the prwAokw a of ChqAor 9(irnnma ock vrlltt$oWan 700%d Div dm <br /> 3 offt Btfrirlelw and Pmb@W om Code and ny liww Is In AM boa and effect <br /> IJosnae,t g3eplrafpn Data: �f�l,�aZ <br /> Datx {f �! ....g:attbadar �N `.•�+�t-(PI.-t•NG . lh1G. <br /> Pddf ed eadta: <br /> tirORRERW COMPENSATION DECLARATION <br /> I heahy mm uww penally otperplty one d the RLWA p dedarelimoc (CHH MC ALL Tf IAT APPLY$ <br /> 1 hews No tell nSidaio at WWAaW of cw amd in selPinum for workeW compensaron,as provided for by <br /> 8aoron 3704 of fro Leber 0001/for lite pwlornwn D8 of U*►wrk torwtlich l*Parnx b fstWwl, <br /> I have and will maktadtl wlakdra'oompdrsreran Inaumncaj as rmqukW by Salim 3700 of ft labor Cods„ <br /> fat ate perinrlrlsetceaf the walk for which ibis p0mll is issuda Mlt wrorttea'axttpataaron dtwraltce <br /> carder mod p owl maw. <br /> "fir W. Ll SGr�4t Yy��' I t S Pettey Nudrber, c S l kS7 4�i33q Ol d <br /> 1 catty Ibat in qts pMttxatsnae of to work for which Us pama is boue4 I shat not employ arty pwaon in <br /> ery maturer so as to beeorns aub(ed b vo wgxliae'corrpeneadon lows of g ommafa,No own ghat UI <br /> should baccom subjedb the wmkW curpwamimn pmvmns of Section 3T00 date Labor Code,1 tdtar <br /> mlrtwm dangly with#x"W"Wotts. ' <br /> Die: �91a, ���_ <br /> P►lrwad"WWrA44 , 44x6 <br /> WAPW16 PAr)1MIETO99CUNErttWJUSWCOMPeNATiONCMRAGEISUMLAWFLI.AMDSMAtLSlWWr <br /> AN EmpLan3t TO CRNUAL PF_NRITIE$AMDtl11n.FUM UP TOOIIE MJMOR[A TMXMAND Dtl AAM <br /> (t14R10W1 INAWFnOUTOTMR fOT CF COL"30ItTION.WMRE3'f,ATTORMEM POiSe AMDDANAM AN <br /> PROYIMPOR rl SEC710M SM OFTW LABOR COOS, <br /> &4a ,/ 4.�,s.ac s7 rained auewtuad rspasattb 9=L hnaby <br /> aVlhprllea_ �-S t•C IMV 7 1�,�(' wr/ <br /> to olan Ola Sm IlaugWro OW.&W Wad ftmW Appdoaion on my- - lr l trtdarsane tlia aaeforlsasaet b Tatltp lbr <br /> ane 1 end a smlbd bRetntwatk dated oa Sr ttorR d ellb <br /> 747 -49"., vnnla It iT : rr eeogi.r n.• .n•Tr n'nv �T/rn <br />