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A SOAP,D OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING James Culbertson, Pres. City of Lod', Patricla E. Vannuccl, Secy. 1601 East Hazelton Avenue, P. O. Box 2009 San Joaquin County Tommy Joyce City of Escalon Earl Pimentel Stockton, Callfornla 95201 City of Manteca Fern 209/46781 City of Ripon Daniell L.L. Flores 6-6City of Stockton John D. Mast, M.D. City of Tracy William J. Wade Joyl Khanna, M.D.. M.P.M., District Health Officer San Joaquin County Mary Anna Love San Joaquin County RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE In order to comply with State and Local Laws relative to contractor licensing and Workman's Compensation Insurance requirements, we are asking that you provide this District with the information requested below. Please answer all of the questions and return the original of' this letter in the self-addressed envelope provided. Ron L. Valinoti , Acting Director Environmental Health Division BUSINESS NAME WESTERN GEO—ENGINEERS BUSINESS ADDRESS Rt #2 Box 177 CITY Woodland, CA zip 95695 BUSINESS TELEPHONE NUMBERS (1) (916 ) 662-4541 (2) OWNER.(S) (1) Jack E. Napper (2) President OWNER(S) ADDRESSES (1) (2) OWNER(S) PHONE NOS (1) (2) CA. , CONTRACTOR LICENSE NO. ISSUE DATE EXP. DATE LICENSE CLASSIFICATION (A,B,C) IF "C" INDICATE SPECIALITY NOS. Jack E. Napper Calif . Registered Geologist #3037 IF "C-61" CLASSIFICATION, I-NDICATE TYPE/S OF LIMITED SPECIALITY/IES. ARE THE LICENSES LIST,ED .ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING? YES x NO IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY WORKMAN'S COMPENSATION INSURANCE? YES x NO IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES NO rA — -- IF YES, EXPIRATION DATE Unknown (mailed to Laurie otulla , R .S . 5-4-87 ) SIGNATURE / TITLE 2resident DATE 5/5/87 - EH 05 30 -sit;