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�'M f)` :X1' FFAri lajOf)2 <br />Pe fking j <br />` Lot <br />C � D <br />uni IV W Perm p n uppl®meat <br />r San Soaquln Gou/—nFy ironrncntaVle Servif�V Al <br />O �7Zb <br />JOB ADDRESS: ua aro a <br />L10EN ED CON2T p, k cT1 <br />11wPE T10 (LCD) <br />'f 38,1 j <br />j <br />ec 1 nereby affirm thet I am liccr '&d unc}er ifac pr i ns oFrCys jI ( r <br />�inCin$ t of CiviSl�7r3 <br />3 of the Eusrness and Prot Ions Code and n y icer%final! rc dLlTectl. <br />Expiration Da e: <br />License I <br />f I <br />r _ <br />DLate. <br />? � itlo <br />PriatPd name' l' MW -6 1 <br />/ wORKERbP' bMA ENS Q�9k=9FAT10 <br />- }n Nir. adraEi ns <br />CH ALL THAT APPLY) <br />h r. affi n p nalty of penury c I I <br />66N V1f�'LL' dM�l-� � <br />I = and a,i am a c o�cor* t <br />i` -,n9 .dr nor rs pansation. 3s prn t d -d icr b <br />6 n 3700 cf the abor G de, of C. fur ich tj�i P <br />V/ h y, _. rnoi W wqr rnpcnsat14�n1t summa as �� U. by S do 3?00 of tnP labor <br />h lssu-d.j y w er;'j orn en$at, ` <br />orr,.a c w rk o, i <br />ie I ICY n e: f JB.Q I Building <br />Pv'b <br />Carrier,. 38.b2 <br />I <br />orpt is iss d, 1 I aH of empioy any Person m <br />BAN`` N '�+4 ena t on i - of ifornra, an ag <br />any manner o 5e :e s bJt�CF. F ran 70 sha'1 <br />should becorne su' ect to th9 arkeCS ca � ! Heinz Propert <br />torthwith cornp w1 ii;ions. <br />_._._,_,_,_•- _ - - - - `canal <br />Date,. Signatures; <br />39.13 90 <br />Printed Name:-- <br />V <br />WARNMG- FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE'S UNI-AWFUt_, AND S 1q0 <br />0 <br />AN arAPLO`(ER TO CRIMIKAL PENALTIES <br />AND CIVIL FINES UP 7O ER �E N TGRAlJ:Y THOUSAND; EES. AND AMA(BS AS <br />(51D0,000.), )N ADDITION TO THE COST OF COMPEN5A,1D <br />PR VADEO FOR IN SECTION 3706 OF THE LABOR COOS- 39,8 <br />Monitorl X�kl� <br />stated July, 1987. �� Groundwater Elavatlon Contour, <br />i ,(C -Z7 ficenreA� IJt drr�/ 8 tive), hereby <br />1,' <br />r e�f>ttUXO�1�� n to ri 4 1 11 1; i t L� <br />• V orization is vaiici fcs <br />t o tFt -L} (jt@tftUnty Wel{ Perms: ASA iaat;on on rr y bsbM fl� dHF�n 4i4� <br />Dsstruotions, <br />one (1) year and is {invited to trw workmen dated on the front a 1 _ .�fCjlCt AiQ 4090- <br />_ <br />year . Scale: 1" = 100' <br />Mr. Ed's Muffler Date: Jan. 2004 <br />st <br />Wright Environmental Services, Inc. 8 -,say, CAI Street. <br />FIQYrr <br />Tra cy, CA <br />