Laserfiche WebLink
f <br /> I. <br /> I <br /> 1 _ <br /> --12/03198 THt? 17:28 FAX GROUNDWATER 2002 <br /> .'13PFt• FRpNt �• 2 I <br /> f i ) <br /> CONTRACTOR/CONSULTANT QUESTIONNAIRE <br /> PUBLIC HEALTH SERVICES <br /> SATs SOACUtN COUNTY <br /> EWIRONMENTAL HEALTH DIVISION <br /> P_O. BOX 388 STCCKTON CA 95201-0388 <br /> OWNER INFORMATION <br /> BUSINESS NAME : 6 <br /> A 6 R Drilling, Inc. <br /> ADDRESS : 2475 Cerritos Avenue <br /> l <br /> CITY/STATE/ZIP: Signal Hill, CA 90806 '1 <br /> 1 <br /> i <br /> PHONE NO (562 ) 424-9992 PHONE ND 2 ( ) FAX NO ( 562 ) 424-5767 � <br /> OWNER #1 INFORMATION OWNER #2 YNFORr1ATION <br /> KAME: Amin Kalife N�''�E Tamara Kalife <br /> 2544 Prosser Avenue 2544 Prosser Avenue <br /> ADDRESS: ADDRESS: <br /> f ' <br /> CITY: Los Angeles, CA 90064 CITY: Las Angeles, CA .90064 <br /> j <br /> + STATE: CA ZIP: 90064 STATE: CA ZIP; 90064 <br /> LICENSE INFORMATI-�;N <br /> CA CONTRACTOR LICENSE 492082 DATE ISSUED O'Si /31 / 86 EX DATE 0'5/31 J 00 <br /> I <br /> LICENSE CLASS 1 C 57 LICENSE CLASS 2 1 LICENSE CLASS 3 <br /> "C" SPECIALITY $' S C 57 <br /> TYPES OF LIMITED SPECIALTY (IES) <br /> LICENSE IN GOOD STANDING? �.J N WORKERS COMP INSURANCE 24 <br /> WORKERS COMP INSUP—MCE CERTIFICATION ON F:LE WITH E H .D. <br /> EXPIRATIOM DATE 07 / 01 / 99 <br /> i <br /> HAZARDOUS WASTE CLEAN UP CERTIFICATION? Y N <br /> - CONSULTING FIRS INFORMATION <br /> SITE MITIGATUDN CONSULTING FIRM? Y N SA-1PLING FIRM? ONLY? Y 17 I <br /> CA REGISTERED OR CERTIFIED GEOLOGIST/RNGINEER? Y N I <br /> i <br /> a <br /> I 1 <br />