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PUBLIC HEALTH SERVICES <br /> SAN JOA QUIN COU NI Y <br /> )061 KHANNA NI.D.,hI.P.11, ^ <br /> Healeli Officer <br /> R U. [lux 20U9 a (1601 Fast Ilax0tun Avrnur) a Stackcun,California 95201 Q�1Fii.r! <br /> (209) 468-3400 <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 /> Department with the information requested below. Please answer all of the questions and <br /> return the original of this letter to Public Health Services Environmental Flealth Division. <br /> Ron Valinoti, Director <br /> Envlronmentid Health Division <br /> BUSINESS NAME Hunt Drilling Inc . <br /> BUSINESS ADDRESS P.- O . Box 1121 —CITY-Jackson , CaZIP 95642 <br /> BUSINESS TELEPHONE (1)_2ng_2?a 2nj 1_ (2) 2r.-2h?-[Icing - -- <br /> OWNER #1 Les Calkins OWNER #2 <br /> ADDRESS 19825 N . Hwy 99 , Acamp%DDRESS <br /> PHONE NO. 209-368=9255 PHONE NO. <br /> CA., CONTRACTOR LICENSE N04a375.2 ISSUE DATEEXP DATEI-: S- y <br /> LICENSE CLASSIFICATION (A, B, C) 1F "C" INDICATE SPECIALTY NOS._,_, <br /> 7 <br /> IF C-61 CLASSIFICATION,`INDICATE- I'Y1 E/S LIMITED SPE <br /> ARE THE LICENSES LISTED 'ABOVE CURRENTLY ACTIVE AND IN GOOD <br /> STANDING`! YES NO_ IF YOU ARE SUBJECT TO WORKMAN'S <br /> COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY WORKMAN'S <br /> COMPENSATION INSURANCE? YESk:::-WQ <br /> 1F YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS <br /> DEPARTMENT? YES_ NO F YES, EXPIR "PION DATES 1- f <br /> SiGNATUI�-� 1 - <br /> '1'1`1'LE <br /> DATE S 7- 9�2_ <br /> t:l! 00 09 <br /> A 1]ieitirrn rd Sin)ua+juin t'uwup !!edlrle Fire Se,^vi;rs 40 <br />