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J+ <br /> SMJOAQUIN COUNTY <br /> JOGi X{ANNA UD,k kik. <br /> P.B. Baa 14Q4 + t16Ai EW F I-hun Avstw ) + Stuvi'wn,Cilifutnij U52ol <br /> (M)468.3400 <br /> C& IFORNIA LICENSM COYMCTQR QuUnONNAW <br /> Tn ordar to o=ZPly with State and Local LAvz relatives to c antractor <br /> ].SCww'M AAA Wpr +a ComPenaation Insurance requircments, >.,,46 are aakinq <br /> tit you prOVids this District with tDe information requested`below. <br /> pleaGO an vOr all Of the questions and return the original CS this letter <br /> to Folia Health servisas Environmental Health Division. <br /> Ran Valinati, birdator <br /> - Environwntol HaAIth Division <br /> BUSUM9 NAXIC Try- <br /> Al <br /> 9alt �,i8 AD�1i �°Y IIF <br /> SUmus TELEPHONE (2) <br /> -- ai GUS I frCr�'I f <br /> OR= IFa <br /> MONE No. �KWX NO. - <br /> map CONTRACTM LTcEtDIE C. �? umm DA's Z" DATE <br /> LICENBN CI0U3Xr7CA== A Re _ IF WCV INDICATZ SPZCMTY NOS. <br /> IF "C•Gl" CLUE17Tc'AT3ONe INDICATE TYPE/3 OF LMI$ED SPBCIALTY/I3S <br /> T LI -LZBM AWV%' CURRENTLY As.'='IVE AN % di®6C STANDINC? k AT <br /> IF YOti An xftm TO WORKUK+S COMPENSATION LAWS OF CALIPOSMIAr DO YOU <br /> Y V=XWW'a CoWiNSATION INSURANCE? VEs , No <br /> IF YSi l NAVE yix FaLW R =TxFXCATZ OF INSURUCE iiM'K THIS DISTRICT?g) N <br /> IF I is► RTYON CATS <br /> '. BxANATU� <br /> T3TLE <br /> DATE <br /> A r7 nwo rF Un G"q Mrah Goa <br />