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10/25/2005 14:53 2095224 <br /> GEOLOGICAL TECHS PAGE 02/02 <br /> FROM :%sonant5oniolnternatio FqX IJO, :5306682429 ct. 25 2005 02:49PM P2 <br /> 10/24/2005 11:40 NAS 7149890759 WEST RAZMAT 0002/001 <br /> FROM :RlesrxiantSaniR[merrational FW( HO. :53®5682429 Oct. 24 20W 1V54AM , P2 <br /> 10/24/28e9 11:22 2995224227 CMEOL0QjCAI_ TE.eNNICS PAM 02 <br /> se'��We vun* sMMMlkmo OapmfNterq Usk N g $alpplsrrtartt —I <br /> JC*ADDRMB: Powir 9fteh <br /> LICENSED CONTRACTORS DECLARATION (LM i <br /> I harelfy s!(lmI <br /> OWI am IkWomed Unaw the pr"MI hr nr Chapter o(t0IrlmengiiB with 9%otlal Togo)of Dlvfa)cm <br /> 3 of the Nuflnew am-PrcNM4lonc Code end my I;csnse Is In full iarca and Offset <br /> L)otxiae tl _ $7 5Y Ese4Nlon Data: <br /> '"— —` <br /> t1aU; is-2 o s C <br /> ontractor; /a'z+ i4+��44t w.i C�� Q�. WeI, <br /> , <br /> 0.-, <br /> •« — — <br /> fifllMdd nrmw; enrtdlf"I <br /> Mf0 RS' CoMPINBATION mjcLARATIoN <br /> 11101 affirm.Under penalty of p"ane of the follewlnu deefsr4dwa; (CHECK ONE) <br /> 1 haft and VIII nlelnISM•*W"CUM Of consent tO Mtf-insure for workers' eumpenseMen.la pfbvided for <br /> by lllscUon 37M Of ft Labor Code,for irw parformenea of the work for whbh this pxm8 In taepuetl. <br /> X'I have end Wil rnaintuo wofksra'eompsneation lnsuranoe as eel by ss <br /> rMG+jlrdlon 3746 of the LeCOf Code <br /> for ow perld"ance of pfd work for which%4 D mft l9 Issued. myr arkars' 001137 U on iheuranre <br /> MFW and II nuynwu are: <br /> 5 PWWV Number. 2L V Abdtt_F^ 7131 <br /> I a+rtfY that In II Pwj0 canoe of the wvrh for whkltt tt"perm N i9mmd, I•batt not amply a'parson in <br /> any meroier so as to beamw subIdd to the worksm'campef»aHan ISM of Callfem)a, and agree that d <br /> should been"mutoot to the wlado"'compensstbn movismh9 of Sect' Code, I Shall <br /> %few "',Com*WId1 ewe proyiII <br /> Owe I <br /> MOI. Y. )A<., sl°"af"ret�7 <br /> py+naa Hann+ cNrtrse 0Ler'e t4y..7 r <br /> VMNtMd01 RALLWA TO a Wft WOMPaWdr CUMVIIIIIIIII C.OVEKA 6 IS uNLAWP IL,AND SHALL autIJECT <br /> AN MKOVIM TO CN)MkAL PENALTlri AND GML PJNI UP TO OW tatN)p W THOUGAM DQI.1AM <br /> oo 111164 IN ADDITION TO THE ppt►T OP GIMPOWAIM,WTtBMtiT.AT►ONIMV g FEES,AMDAMA41Cd As <br /> PROYMM FOR IN a!umm ilaC OF TIM <br /> AUTHO law .Ql -Aft THAN C.¢7 SIONIPM PERMIT APPUCATfON <br /> 4---�'''�= (alONwre of 047 pa,,.�.a sumsnr.d <br /> rpresentatlw) <br /> hVft autherlss(pAnM rraRr) . <br /> !e Ilrarr tfas sari Jersgvin Panel ApplleaMon ar+my handf I4edersland SMa aaelpriaartien Ie va9d for <br /> d"s 11)ver and(a Irr»had to the weak pit"da W en M1e boot pads of ells spp♦lowpprl, <br /> a 08/MIM <br />