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d-07-1997 d:22PH FROM FISCH ENVIRONt<1ENTAL 2097723571 P. d <br /> FISCH ENVIRONMENTAL <br /> 399 SHERI'S PLACE VALLEY SPRINGS,CA 95252 <br /> PHONE4(2091772-3570 FAX#(209)772-3571 <br /> San Joaquin County <br /> Environmental Health Division <br /> 304 E. Weber <br /> Stockton, CA 95201 <br /> RE: Workers Compensation Exempt <br /> Ilnder the penalty of periury, I certify that in performance of the work for which this permit is <br /> issued, .I shall not employ any person in any manner so as to become subject to the Workers <br /> Compensation Laws of the State of California. <br /> Date: ��rJ Signature: <br /> Contractor Name: .-DAV TrSC-1 <br /> Company Name: .1�_ _��iU IVZO kJCY1 � <br /> Company Address: _ f�}'l <br /> City, State, Zip Code: < ,D, ►1'1G�5 �1 joZ�� <br /> I - <br /> Company Phone Number: �7-7 - <br /> CSLB License Number: ' <br />