Laserfiche WebLink
60A1111 <br /> #am*@ Cuib�anaon, Praa,of TRtJfTEEs SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Jima, lERV1Ff0 <br /> Patricia C, vannycel. Stc'i, City nt Lodi <br /> TOMMY Joyce ItKJI LAS1 Mazoilon Avenve, P. 0. Box 2oo9 San Joaquin County <br /> Earl Plmanlai StoCkion. California 95201 C11rof Escalon <br /> fern Sugosa City o1 maniacs <br /> Daniel L. floras 209/466-8781 City of Ripon <br /> John 0. Masi, M.Q. City of Stockton <br /> William J. WaeTe J001 Khanna, M.O., M.P.H.. District meailh 0fficar City of Tewy <br /> Mary Anna Lora Ban Joaquin County <br /> San 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 /> [turd L . Val inut i , Diret:t_or <br /> BUSINESS NAME l��� I;nvironmc:ntal Ilealth 1.4vi5ion <br /> �i��� <br /> BUSINESS ADDRESS 171c h �,1►� s/ CITY ZIP X531 a <br /> BUSINESS TELEPHONE NUMBERS ( 1 ) e?,S --_3gC) 7 � <br /> (2) <br /> OWNERS) ( 1 ) crssef ,� <br /> OWNER(S) ADDRESSES ( 1) /7/0 !�-�,, 5,y (2) -_ ms s <br /> OUNER(S) PHONE NOS ( 1 ) S3�s-3sc�i (2) <br /> CA. , CONTRACTOR LICENSE NO. _ ISSUE DATE _ EXP. HATE <br /> LICENSE CLASSIFICATION (A ,B,C) _-` [ "C" INDICATE SPECIALITY NOS. <br /> IF "C-61 ""C-f[ " Ct.ASS[FICATION , INDICATE TYi,F/S OF t, IMITED SPCCIAI_ITY/ ICS. <br /> ARE THE; LICENSESLISTEDABOVE CURRENT(.Y ACT IVC AND IN GOOID STAr4 jjj%? YES NO <br /> IF YOU ARE SUBJECT TO WORKMAN I S COMPENSAT (ON LAWS OF CAt. IFORN[A, 00 YOU CARRY <br /> WORKMAN' S COMPENSATION INSURANCE? YES _X _ NO _ <br /> IF YES , HAVE YOU FILET? A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? YES % . NO -� <br /> IF YES , 'EXPIRATION DAT[ <br /> TITLEDATE //36 /R j -- — <br /> TOTAL P . 10 <br />