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PT TBLIC HEALTH SERVICES <br /> p � SAN JUAQUIN COUNTY � <br /> JUGI KHANNA M.D.,I`t.P.H. <br /> pUG 2 61992 HealthUflicrc '� <br /> N.U. hux 2009 . (1601 Bust Ilazdton Munuc) a Suck-um, California 95201 9c�Fo,a <br /> (209) �iGR-31ou <br /> .�pE�RMIT/SERVICES <br /> RE: CALIFORNIA LICENSED CON'I'R.AcTOR 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 /> Department with the information requested below. Please answer all of the questions and <br /> return the original of this letter to Public l lealth Services Environmental health Division. <br /> Ron Valinoti, Director <br /> Environmental Health Division <br /> BUSINESS NAME The Twining Laboratories <br /> BUSINESS ADDRESS 2527 Fresno Street CITY Fresno Z113 93716 <br /> BUSINESS "TELEPHONE (I) (209) 268-7021 (2) <br /> OWNER #1 Harry D. Moore OWNER #2 <br /> ADDRESS 2527 Fresno Street; Fresno ADDRESS <br /> PHONE NO. (209) 268-7021 PHONE NO. <br /> CA., CONTRACTOR LICENSE NO. 506159 ISSUE DATE 2-90 EXP DATE2-28-93 <br /> LICENSE CLASSIFICATION (A, B, C) C57 IF "C" INDICATE SPECIALTY NOS.— <br /> IF "C-61" CLASSIFICATION, INDICATE TYPE/S LIMITED SPECIALTY/IES <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD <br /> STANDING? YES NO,_ 1F YOU ARE SUBJECT TO WORKMAN'S <br /> COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY WORKMAN'S <br /> COMPENSATION INSURANCE? YES x NO <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS <br /> DEPARTMENT? YES_ NO x IF YES, EXPIRATION DATE <br /> SIGNATURE <br /> TITLE Geotechnical Engineering Division Flanager <br /> DATE <br /> l.:ll 00 04 10 <br /> A hivisinn to(Sari)uaqu •�� <br /> ui"Cuntq F!r!!�!t f gee S< iic^� <br />