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10-OS-1999 12 SlPM FROM P 2 <br /> OCT-04-1999 16 59 FROM PRECISION SAMPLING TO 120Y4b1l-34,33 P-W2 <br /> saa io"g its ca atyr&WWWWWe>bl RiWh 8wvF-=s,Ut t IV WON Perms App6c*Wn S4pplaONt <br /> JOB PERMIT st�- <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm VW 1 am licensed under ttte pra tlm of Ct=PW H(comrMnoing witte Seddon 7p00)of DIMS= <br /> 3 of I*Susrhe3s and Pfa*mions Code anis my rK=w Is In fuli fom e,and eflecrt <br /> Licenser#: Expiration Date. <br /> Orate. <br /> 6qgnatu+ra_ Tatw <br /> Pr47bd <br /> INORKCr:W C4WEN5d4TION OMLARATIOM <br /> I hseroby affifm wader pwr ty of pectisy one of fres bdowrng dectatrabwm (CHECK ALL THAT APPLY) i <br /> I hme 2nd wW fiia nbkj a wrbfr4te of carts&*Ju selF.mwe for wodeW connpects;ai+m.as pnvvWed 1br by <br /> Secfiw 370a at tw Labor Cade.fw test p wkx-.aye of ufe wack ftr w1wth Um pemut,s zaued <br /> 41 have amd welt tn®ertt Wn workere e*&Ve*A jQn a tvAm vice,as tegvuvd b7 Secbw 3700 Of the L.abar Code, <br /> for the per kwma ce of the om k tbrwhtch VA pwvA is wased. My camel m compensation iftu tee <br /> Carrier ffi�d po6G)1 Rutte"s am, <br /> Carrie: -,1 caL �eD policy Mumh'r, <br /> I ces*ythat In the pedbrreWCS of the work Ibr w sit# t;SDo"is issued, t stead Rd en by arr 1eman In <br /> any master so as to become subject bo the workeW acmAeramfon tsars of C;afdom'ta.and Xyee fact if 1 <br /> abould became subpom to the worloarec�oervww. sEion pmviskxw of Section 3700 of the Labor Code. 1 shalt <br /> fort wth tonviv va th a PWASrarm <br /> Data! ft: <br /> Printed Nance. <br /> WARRING.FALLU E TO SWURE WOR .9W C 0WQ(3AnQN COVERAGE tS WILAWFUt,AND$HALL WMEC'r; <br /> 1W DYER TO CRItANAL KNAL'YM AND 0VIL A1l8S UP YO CME iilJA OMDTHi7k S"O MOL ABS <br /> t O%6W).Ni A CNVM N TO 7NE cONT CW CC WEW5^7Tcak timni.,sr,A'ITORNEY's FUM AND A5 <br /> PROMUD FOR IN SECMK XM CW THE LAWR Cts <br /> T C457 lamed wj*mllvi*herr <br /> OF <br /> ag"afw San.ToagL"cvjnw wee saso ;t Awr,o oa or!mar b~ 1 uxtiersmnd efv:author`r n to+rte idr <br /> ons tt x d is QmUd to on wcm& dated vr►em front MM or O is a <br /> poat-ar�t� <br /> 7lhIt °au 10 q1 �- <br /> SUTAL P.82 <br /> TOUL P.02 <br />