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BOARD OF TRUSTE93 SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> Jamas Cu148rtson. Pres. City of Loch <br /> Patricia E.vannuccl, SaWy. 7501 East Hazelton Avenue, P. 0. Box 2009 San Joaquin County <br /> Tommy Joyce City of Escaton <br /> Earl Pimantal Stockton, Cal)fornla 95201 city of Mantaca <br /> turn aupbeo 209/A68-6781 City of Ripon <br /> Daniel L. f=loras City al Stocklon <br /> John 0. Mast. M.D. City of Tracy <br /> William J. WeAe JoCl Khanna, M.D., M.P.H.. District Health Officer San Joaquin County <br /> Mary Anna Lovo Sun Joaquin County <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE <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 /> Ron L. Va l i noti , Director <br /> Environmental Health Division <br /> BUSINESS NAME WAYNE DRILLING CO. OF CA. <br /> BUSINESS ADDRESSP.O. Box 726 CITY Lincoln, Ca. ZIP 95648 <br /> BUSINESS TELEPHONE NUMBERS (1) (916) 645-9355 (2) (916) 965-9355 <br /> OWNER (S) (1) Steve Hedman (2) Linda Hedman <br /> OWNER (S) ADDRESS ( 1) 1800 Fowler Rd. 6(2)) same <br /> OWNER (S) PHONE NOS (l (91 6i h63=3205 5 l 1 <br /> same <br /> CA. CONTRACTOR LICENSE N0. 376345 . ISSUE DATE 6/79 EXP. DATE 6/89 <br /> LICENSE CLASSIFICATION (A,B,C) C-57 IF "C" INDICATE SPECIALITY NOS. <br /> IF "C-61" CLASSIFICATION, INDICATE TYPE/S OF LIMITED SPECIALITY/IES. <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING? YES x NO— <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES x NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES x NO_, <br /> IF YES, EXPIRATION DATE 1/1/90 <br /> SIGNATURE ` <br /> TITLE Owner/ dministrator <br /> DATE 4/17/89 <br />