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WP0040700
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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DELTA
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8121
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040700
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Entry Properties
Last modified
5/18/2020 4:57:14 PM
Creation date
5/18/2020 4:53:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040700
PE
4371
STREET_NUMBER
8121
Direction
W
STREET_NAME
DELTA
STREET_TYPE
AVE
City
TRACY
Zip
95304-
APN
21302003
ENTERED_DATE
4/2/2020 12:00:00 AM
SITE_LOCATION
8121 W DELTA AVE
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> EXTENSION OF INFORMATION PAGE <br /> Policy Information Page Schedule <br /> Item 4 <br /> Insured Name: Fox Loomis, Inc. <br /> Effective Date: 10/01/2019 <br /> Expiration Date: 10/01/2020 Policy Number: FOWC012986 <br /> Premium Basis Total Rate Per Estimated <br /> Code Estimated Annual $100 Annual <br /> Classification No. Remuneration Remuneration Premium <br /> State California <br /> Effective: 10/01/2019-10/0112020 <br /> Millwright Work-N.O.C. 3724 6.59 <br /> Drilling-N.O.C. 6204 14.76 <br /> Construction/Erection Yards 8227 8.25 <br /> Salespersons-outside 8742 62 <br /> Clerical Office Employees N.O.C. 8810 .46 <br /> Blanket Waiver of Subrogation 0930 1.020 <br /> Experience Modification 9898 960 <br /> Risk Adjustment <br /> Tot Est Standard Premium 10/01/2019-10/0112020 <br /> Premium Discount 0063 .707 <br /> Minimum Premium $3,000 <br /> Tot Est Standard Premium for California <br /> WC 99 03 13 <br /> (Ed. 9-14) <br />
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