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ENVIRONMENTAL HEALTH.DIVISION <br /> 445 N.SAN JOAQUIN <br /> STOCKTON, CA. 95201 <br /> (209)468-3420 <br /> CALIFORNIA LICENSED CONTRACTOR QUESTIONNAIRE <br /> Please complete all questions and return. This information is required in .order,to <br /> comply with STATE and LOCAL LAWS. <br /> NAME: DON JAMES SR DBA: PACIFIC .RIM ENVIRONMENTAL <br /> BUSINESS ADDRESS: 'PO BOX 192972 CITY: SAN FRANCISCO ZIP 94119 <br /> BUSINESS PHONE:( 41)5 255-0860 PHONE #2 (809 326-0173 <br /> OWNER #1 DON JAMES JR _OWNER #2 DON JAMES SR <br /> ADDRESS: SAME ADDRESS: 3101 SILLECT AVE STE 105 <br /> PHONE: ( 41f 255-0860 —PHONE:-(80P 326-0173 BAKERSFIELD CA 08 <br /> CALIFORNIA CONTRACTOR LICENSE NO. 649163 DATE OF EXPIRATION: N/A <br /> LICENSE CLASSIFICATION (A,B,C) A LIST SPECIALITY# General Contractor <br /> HAZARDOUS WASTE CLEAN-UP CERTIFICATION? Y X N CERT.# 649163 <br /> CONSULTANT <br /> ARE LICENSES LISTED CURRENTLY ACTIVE AND IN GOOD STANDING? YX N <br /> DO YOU HAVE EMPLOYEES? Y X N <br /> If you answered NO to above, please complete attached waiver and submit with <br /> questionnaire. If YES, please provide Certificate of Insurance and complete <br /> information below. <br /> NAME AND ADDRESS OF WORKMAN'S COMPENSATION CARRIER; <br /> NAME: DIBUDUO & DEFENDIS INS <br /> ADDRESS: 5665 CALIFORNIA AVE STE 100 BAKERSFIELD CA 93309 <br /> PHONE 805/322-9993 AGENT mike Je l l et i ch <br /> EXPIRATION DATE: 7/4/94 <br /> SIGNATURE: <br /> i <br /> Page 14A <br /> I <br /> I <br />