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01/24/89 18: S 916 662 1592 WRTE EV. CORP. 02 ` <br /> ecaRo or YRu4TEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Guluertaon, Mro$. <br /> City 01 County <br /> Pe!fkis E. Vennucci, Secy. 1501 Fest tiaxetton Avenue, P. O. Box 2009 Sand City <br /> colon <br /> Tommy Joycs Clly ol6acaton <br /> Ear! plmenfe! SloOklon, Ciallfornla 95201 City of Mantace <br /> Fern Rugb** 2090465-6T8r yofStckton <br /> on <br /> Daniel L, r ioree City it of Tracy <br /> John 0. Meat, M.U. CltyofTracy <br /> Wifilo"ni J. :ass Jogi Kh*nna, M,i ., dd,P.H., DialrIct Health o t of San Joaquin County. <br /> Mary Anne Love <br /> San Joaquin County <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUEST1014NAIRE <br /> In 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 /> i <br /> Hun L, Val inut,i , Dite<:Lur <br /> / n _ EnvironmentalNeult/h Division <br /> BUSINESS NAME 1�r7_ t/Q?fi& �' ra10/1 ��e� pavr, T: evi <br /> BUSINESS ADDRESS , CITY ZIP <br /> BUSINESS TELEPHONE NUMBERS - <br /> OWNER(S) ( 1 ) ( K4� 1� (2) — <br /> OWNER(S) ADDRESSES ( 1 ) � (2) _ . .-- <br /> OWNER(S) PHONE NOS ( 1)�ac�nLav C (2) <br /> lL_' G.G -2 2 --- —.. _ <br /> CA. , CONTRACTOR LICENSE NO. r2 � ISSUE OATS EXP. DATE _ <br /> LICENSE CLASSIFICATION (A,B,C) IF "C" INDICATE SPE.CIALIIY NOS. <br /> IF "f,-61 CLAS SIF ICATION, INOICAIL TYPI /S 01 I. 1"1110 SI'if: lAI Ilr/ tl ', . <br /> -i <br /> ARE THE LI . "NSES LISTED ABOVL (URRENIt.Y ACTIVE AND IN GOOD S1AW)ING? YES X HO <br /> IF YOU ARE SUBJECT 10 WORKMAN' S COMPENSATION LAWS 01 CALIFORNIA, 011 YOU CARRY <br /> WORKMAN'S COMPENSAIION INMIRANCI ? YS �' NO - - --- <br /> I F <br /> --IF YES , HAVE YOU FILED A (.E RT IFICAIL 01 1NSURANCI WITH THIS UISTRICI? YES d NO <br /> IF YES . EXPIRATION DATE /%� --- -- -R— -- <br /> SIGNATURE�� r3.V>GL+.� ._—. <br /> C4�S.F4 _ . ... <br />