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BOARD OF TRUSTEES PUBLIC HEALTH SERVICES <br /> ' <br /> lama# Culbsnaon. Plea. San Joaquin County SERVING <br /> \,,.,atricla E. Vannuccl, Secy. P,0. Box 2009 City or toot <br /> Tommy Joyca ca (1601 East Hazelton Avenue) San Joaquin County <br /> Earl Plmontel Stocktonr California 95201 City of Eacalon <br /> Farn Bu bee -•--• •- • __..._...._ ____. City of Manteca <br /> G .. <br /> Daniel L. Floree 209/466-6781 City of Alpon <br /> John D. Mast, M.D. City of Stockton <br /> William J. Wade Jo0l Khanna. M.D., M.P.H., Oletrlct Haalth Officer Cityof Tracy <br /> Mary Anna love San Joaquin County <br /> Son Joaquin County <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE <br /> In order to comply with State and Local Laws relative to contractor licensing and <br /> Workman's Compensation Insurance requirements, we are asking that you provide this <br /> District with the information requested below. Please answer all Of the questions <br /> and return the original of this letter in the self-addressed envelope provided. <br /> Hull L. Vttl inUti , I)i r i.!t-tur <br /> Environmental H0.1.1 t.h Division <br /> BUSINESS NfME: DECON Environmental services, Inc. <br /> Suite 4 <br /> BUSINESS ADDRESS <br /> _26102 Eden Landing RdCITY Hayward, CA ZIP 94545 <br /> BUSINESS TELEPHONE NUMBERS ( 1) (415) 732-6444 (2) <br /> OWNER(S) ( 1) glee Attached (2) <br /> OWNER(S) ADDRESSES ( 1 ) (2) <br /> OWNER(S) PHONE NOS ( 1) (2) <br /> CA. , CONTRACTOR LICENSE NO. 545726 ISSUE DATE 11-2-88 EXP, DATE 11-30-90 <br /> LICENSE CLASSIFICATION (A,B ,C) A, C IF "C" INDICATE~SPECIALITY NOS. HAZ, Ass <br /> IF "C-61" CLASSIFICATION, INDICATE TYPEIS OF LIMITED SPI.CIAL11Y/ l[S. <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING,? YES x 140 <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY <br /> WORKMAN'S COMPENSATION INSURANCE? YES x NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES <br /> `�- IF YES, EXPIRATION DATE see attachment 1 <br /> SIGNATURE <br /> TITLE <br /> DATE g5 <br /> 2 'd OE :so 68/OI/80 wodJ <br />