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Qct --7 .2008 2: 22PM Ra-age Environmental , Inc (77"1 851 -7240 p. 2 <br /> r w <br /> • 10/24/08 04.'JSPM 611 1 aDaaeona=t; $30,e44.1439 �.,.d03 <br /> cONTRACT99S TATE LICgNSE BOARD <br /> W21 Business Park Chive,Sacramento,Caldornia 95827.17W STATE OF CALIFCRNIA ow <br /> Mailing A60esa:P.O.Bm26909,Sacramento,CA 98826 Arnold Schwarameoger,Governor mn <br /> 900.321-=.S(2752) <br /> roya7r�n4c,usi m w.csib.Cs gov <br /> DUPLICATE your License Etip(res on Otlober 31,2008 Q <br /> RENEWAL APPLICATION <br /> FEES: 11 postmarked and OCCeptable by 1=112003: Active.Fee $300,00 or Inactive Fee $150.00 <br /> If postmarked atter 10131F2006t Detingjeni Active Fee $190.00 or Delinquent Inactive Fee $22b.0o <br /> Licenses renewed after the explrattan date will have a break in licensing time. <br /> VOLUNTARY CONTRIBUTION D ConstrnoiorlMana9orrrenilEducallonFundS__—_�._..__. <br /> 848359 <br /> ALL WELL ABANDONMENT <br /> 3809 PLEASANT VALLEY ROAD <br /> PLACERVILLE.CA 95667 valet OR TYVEbq Wit'8s t1ANW8 HERE <br /> PRINT GR TYPE BUSINESS NAMECMAniTEHERE � Mramb■NSuaelor .13ox <br /> Slate ZIP C 08 <br /> IF TME ABOVE BUBIMEr88 InAILI{VB ADDRE3513 A P.O.BOX <br /> Daytime Sualrlesa Phone Number: ) — or PMB THE STREETADDAESS OF THE 91,1911,1Ea$IS AL90 <br /> REOUIkl).YWS YA L BE PUBLIC wFORmAT10N. <br /> BueineasFax Number. ( ) __._._.r_ .__.—__. _ <br /> Business Type:SOLE OWNERSHIP 9usMeas 61res1 Addrael IfJWnbsr$U08I) <br /> Class(es): 057 <br /> cu ➢P Code <br /> Personnel Title <br /> ROe[H7 OEM SLAOI.E SCI.E OWdiER <br /> IMPORTANT:It may take 4 weeks to process the renewAi after it is received at the <br /> headqus a ce of the CSLB.(Timely aubmissle n of your renewal Is strongly recommended.) <br /> READ THE ENCLOSED 1NFORNATIONANSTRUCTION;BEFORE COMPLETING TKIS APPLICATION <br /> PARTNERSHIPS:ProvideiVerily your Federal I.D.Number — <br /> AP PLICANT'S STATEMENT OF f INANCIAL CONDITION <br /> (Answer thisueation it raocllvating Ihla Itoense.)Pursuant to Secten 7[187.5 d 1-Bwhees and Omf..,ions Code,every appf cant,older Shan one <br /> aaapfysrg lora Joint Venlrue 1 Ocense,shaft cess and shnc <br /> ak evidee financial colvenri.For purposes et5ection 70575.Ippncial gOverwy shall eo;eed Two <br /> Th..and Frva Handed DoPars{$2,500]. OOppemadng capital as deflned by Board Rule 1.17:Q7rrent Assets Minus Current Llabiiibm.) <br /> DOES YOUR OPERATING CAPITAL EXCEED$2.5007 YES( ) NO( I <br /> 1LFP6RT'ANT- THE FOLLOWING CERTIF1CA77ON kfUST i3E COIAFLETED WHETNEI4 RENEWING ACFIVE AA <br /> INACTIVE. The certMfcation dame(date,city,coup.y,state)and print name(s)must be typed or <br /> in ink.Tfre signet wo(9)most he M Ink. <br /> at <br /> !Sell faddarrvn ray cCunir 1!018 <br /> intra cerllfy under penatty of perjury,,ymmmeo by the laved of the Elate of Calilan A.tnet air statemente,answers,and representations In this appitcatlon, <br /> Including all supplamentary siclernenis attached hereto,are true&fid carred M Ips qualilier(s).when renewing active.amfare perfarminq ena or <br /> rrore of ria pubes specified in Mein X8 on 0 a 1MAVCilyn sA " <br /> Signature o1 Ownee,Partner,or Oifloor�r"'� �_��"�� __--_..—._� Print Nemo_.. <br /> Signature d Ovalttying rndlvldu9l....._...-.._._.._.�.-..�-- .,..-._ -- -_._.... Print Name <br /> IAA-gwr0.a OF i <br /> Sisrudore of clualayatg Individual_�__,_,- _-__, Print Hama <br /> IKrE fa40.a a�d axt.ro.w aa.•sr�oo�Nu <br /> THIS RENEWALAPPUCATION IS A LEGAL 041-,UMENT YOU MUST SIGN YOUR FULL LEGAL NAME_ <br /> FALSIFICATION OF ANY APPLICATION IS CAUSE FOR DISCIPLINARY ACTION. <br /> 1��1 �1 <br /> f � 111gp����'��I PRINT DATE:10/24/2008 <br /> �� " <br /> •RS 1111IF• 1111111�NAl�IfHl.=1I�U�1(N�I rR®.nserf otrr.�2nos) <br /> '9Q8399' <br />