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Received Dec-15-00 05: 16pm from 415 456 9897 - Mark Becker page 1 <br /> DEC-15-2000 16:52 FROM" ORECISION SAMPLING TO 58313361378 P.01 <br /> v.. . .v wv ow. Fi r r cim ZOV40444JJ o warF beet page 3 <br /> 12/15/2618Z 1dt Rr, ?Ag�aLQ3d�$ FIFTH FL.0MW 02 <br /> r. <br /> can JWCIVIe caumy 6nyramntrtFV0 Nvotth 1jerviam Urtit IV walfpNitwit 40100dop @uPptorrlont <br /> JOD ADDRE05. �UU W, C v�urL� St PERMIT QR& 0 y <br /> i horoby taftm Thd t cm It wood under eta pm,. tanv at Q MupWr 9(oomrpot lag with 8=tlo'17'Qt}t3)of WNW <br /> 3 of Jh0 Woinet s ot7d Pmloc alarm l odo and my llwnro Is In full toren anet 06 <br /> e <br /> l toonse ' 3 ? Exp]radon DOW- <br /> oatv,�. t r2 Q Sq4, k <br /> �tgnt7Lllr4: '�':tlr,c C,t '����,`� �u• S °`-r4�ct�y� <br /> printod name: <br /> WORKERV'CDMPIRNCATION 02CLARATION <br /> }1~aroby itfArn7 undor poAtltty ci PCrkxrY r ttb Gtt Shit f Dilflwlrr�doatartttlerft} (CHECK A L THAT AP PI.1') <br /> d hero end vdit m6ntalrt a oatftato a+aoneant to t3di!tnsuro for wortcGnr'Compo m6onj c4 provWod for by <br /> Soot wl TMO of!first tabor Coda,W om pbrbrmanw of tho work for which thla pormit is bouca. <br /> 1 htw cr►d viii)rr atntoin woftW=Wm&Ven Wa.% tnw.as rcquirad by 9ocdw STd00th-a Lnbot Oador <br /> ter[h4 rrnanoc of the►Mani t'ar wi tlah thla porm3 Ic I6Sae+d. Irby workW avopw=11an inowmao <br /> aorta n7nt4 <br /> Oormor. ,�L ohs txoiiQyrNumbor Oaf ')1 -GZ z334 vdo <br /> i ao+tt�r that m ttto formanq of tho work fpr whloh Wo permit le Lwjod.t&half mat omptoy+any Poem#n <br /> tiny manmv as so t0 i?t?ti omo tsub]wt to tho w0karb'pomp don lewa of Cat wain,toed egme t11tn W i <br /> ch*Wd aoowr4 auh xt to the wo tt rul Wnp=ptton pravtatom of Om0a l$PCO of tttt Lear Code,1&0,11 <br /> f6rthwlth*amply*1h thoca pmvlaierts. <br /> oto: tarn: <br /> ptit+tcd NDRttx <br /> WARIONG.Fo1l All TO MCWW WORKii 4W COMPElHWON COVERAOtf M UM AWRA.r Aw CHALL t3tJl C!CT <br /> Ata EMPWMR TO tAtk NAL PEVALTkU AND CWIL FUM Sia TO ONO O tdtfitl FMV THO00AND O*LLARC <br /> oD000.) In At3WMON TO THE CM OP eMISISM54'PM,INTISWICTr AT11ORNOM Fuca,eras DA'MA200 AD <br /> tW0 FOR Std Cm-VMN OM OF TI113 L W=COOK. • <br /> 4 <� g` ' "o"1Z'I.` fCdiT 11ami=4 authaArad mj==tWvo4 tnreby <br /> !�� .1� ka� <br /> to e$�m(;ft[fit J0c*in 04umcYW011 Porm)tr4ppilelst1cm 021 fifty IS611CIL i unftratcnd thta eft=I*M b vt�ld for <br /> am it)yz=rnd to Itn4tod to W Wo &.clan ddtoG en tt+o frnl►t pqja of%No app:=gen. <br /> Post-Pte Fax Note 7671 Date C aa°ge9a <br /> To <br /> S� /��c, rr From <br /> Co./Qept. - <br /> � e,l Co. <br /> Phonon ��-311 /�1�t71f Phoney ~ <br /> Fan M 1 3 '4 / Fax k <br /> TOTAL P.01 <br />