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SAN JOAQUIN COUNTY � ; <br /> JM MANNA kD,ALP HHeikh War <br /> � <br /> PO Ika 2009 • t 1601 Lug Harrltun Awrrl mi . 4r dwin UIdomw 91%1 <br /> a <br /> Rt: CAL=FORNIA L.IC$'»SED CONTRACTOR QULTTY0NN1i M <br /> 4 <br /> In order to Comply with State and Local Laws relative to aoltractor <br /> liomwinq mA workmanoe Compensation Insurance requiroments_r tie are asking <br /> that yoU provide this District With the information requesto jbelov. <br /> Pleas answer all of the questions and return the original " t this letter <br /> to Public H"It'.h Services Environzental Health Division. <br /> Ran Valinati, bireater <br /> Snvironuaental HeAlth Division <br /> BUSINRBd NAM <br /> RUSI>iS�Bi A�AESS �l'Y tIy°, <br /> BVSINS92 9lRI.IIIDP' XR (1) (2) <br /> f' <br /> Amon.RSa ASS <br /> Ili No. IPRANN NO- - - <br /> t <br /> CA. , CONTRACTOR ZJCWZ0. � ISSC'� DATE EXP �®ATR <br /> LYC=3z Q�AS MOATI0N 8, IF 1°C" YNDICAT$ SPICIALT'Y NQSZZ <br /> IF "C-611° CXAMZFXCATXCM, MICATE TYPZ/8 OF LMT19D SPICIALTY/133 <br /> AM THR Xa LISTRD A"Was CURRS iTI.Y ACTIVX AND IN OOOD STANDING? Y N <br /> 1>r YOU An Xagnm TO N=XHAN'S COMPffiK8ATION rmg OF Ci1L% OdIA, 00 YOU <br /> GMY VRxm•R Co>I MUTM 7.>?1MANCl7 YU 'C. NO ,�.. <br /> YP Yi$, XlV:j Yoo FILM A CEMFICATZ OF TNSMXCE 'WIT>fl< TUTS DISTRICT?t.Y/ N <br /> IP '4722, AT20N UTZ <br /> 81AINAT� <br /> SAM <br /> T1S'i.E <br /> IDAT>$ <br /> A M."M,d Rea)mWM y Mr-kA GO fm ' <br />