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FEB 24 '39 13:06 <br /> ---------------------------------------------- 1�� <br /> --- <br /> MAR 219 <br /> EN�p�MR I SER��ES TH <br /> = E H - 2 4 - 9 9 PRI 1 :3 : 20 RACZPIC ENV . G R O V P P . 0 2 <br /> i <br /> NOAno OF YAUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT arAvlhu <br /> Aw,..C.1O 1... h.• City N Loo <br /> I.okl.E. V......1. ].fp 1601 Easl MKR 700 <br /> eIIOA AVenW,P.0.BOX Can hMq.lr Cayity, <br /> T9,V J.rc, City of eaubr <br /> 4.4 Ftmarut Slocklnn,CMIIMnfa 95701 Cay of M.nt.0 <br /> Fwa vugn 209/4664761 Plv at ru"M <br /> 0.0141 L. FIG/.a City of 11100101, <br /> J,Am O. M.m. U. City of Tracy <br /> WIIIWn J. W.A. Jnyl,han. , M.O.•M.►N.•dWtct wa.IM onk.•. ear JD.quln Cnw.ay.., <br /> Mary Air.Lo•. a�n Jo.quln Counq <br /> RE: CALIFORNIA-LICENSED CONTRACTOR OUESTIOUNAIAE <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 informatiun requested below. Please answer all of the gaestlom$ <br /> and return the original of this letter in the self-addressed envelope provided. <br /> Run 1.. Valinoti , Direr for <br /> Environmental llenith Uiviaton <br /> euslNEss Na,E Al (crriz;lL ►�in���- <br /> BUSINESS ADORES$2.1911-i_hrl /(y. n' -- - MY d,w;llg 1 CA 2 1 P <br /> BUSINESS TELEPHONE NUNOERS 1) f)1(c— 'M- fL'1.>2.2 (2) <br /> OWNERS) (11 )aiI, P fes•_ (7) 5,411y _AvAes _... <br /> OWNERS) ADDRESSES (1) 8 l/) :2jr.Vice ber><yLU. <br /> CWNER(S) PHONE 40S (l)[�M/f4) 77/ -02.1 (7)C9l[,}JJ!-� Q..>x 2•Z_----.- <br /> CA. , CCNTRACTCR LIC06t issur DATE. E1P. DALE 973/ eF <br /> LICENSE CLASSIFILAIIUM (A.B,C) _,.4° - if 'r.' IhOMATF SPLCIALITY NITS. e&1-4- <br /> IF <br /> G/wIF "C-p; • i.LAlDI I ICAI ION. iNntr.AZ fYPr, OF f,TMITEn SPErIA1.ITY11f5 _. ._. <br /> PP <br /> ARE THt LILLMSIS 1 !$117 AVVr CIIRRFN TI Y AF.T IVF AND IN GOOD STAMPING? r6 NU <br /> IF YOU ARE SUBJLCI 10 WIIRKMAN"i CIINPFMSAT!nN IAWS OF CAI IFORNIA, DO YOU CARRY <br /> WORKMAN'S CtQMPENSATION INSURANCE? YES ✓ _ NO <br /> IF Yis, nAvr YOU FILED A CERTIFICATE Or INSURANCE WITH THIS DISTRICT? YES ✓NO <br /> IF YI.S. EXPIRATION DATE <br /> .y SIGNATURE" - <br /> r1�(fGf S�oTC= 3•�•Q1 TI11.E �>_Q� .. _ . .._ ._ -__ . ._ __.•- <br /> MTE <br /> 1 . <br />