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'3UL 26 '93 14:1$ SOILS ENGINEERING INC. EFL r ci4 <br /> res~ ENVIRONMENTAL HEALTH DIWSION <br /> 445 N_SAN JOAQUI°N <br /> STOCKTON, CA. 95201 <br /> 12091468-3420 <br /> f;�LlFORN1A LICENSt D CONTRACT Bat 1E5 1ONNA)RE <br /> Plesas cornptete all gV#Stians and return. This Information Is requbed In order to <br /> comply t:twith <br /> STATE <br /> aand <br /> +sLOCAL LAWS. <br /> NAME:!kgo��r=mI aLP&Q–mW". DSA: Sot_L-s <br /> suslNEss ADDRESS:di];t4lit tt3 &MIDclTv: BPrF;I��S��icpxrp93313 <br /> BUSINESS PHONEAS. J 1Q Q PHONE N2 I I <br /> OWNER #1 I_ Tjp #r& Aq Lt a OWNER 02 MOW1 P9 k1J aXE <br /> ADDRESS: g„--s — d t...�r 4 ADDRESS:, <br /> PHONE: I 1 _ PHONE: I 1 _ <br /> G .S7 <br /> CALIFORNIA CONTRACTOR LICENSE NO, g53 f�L DATE OF EXPIRATION:11I <br /> LICENSE CLASSIFICATION (A.6,C) [' LIST SPECIALITY$r <br /> HAZARDOUS WASTE CLEAN-UP CERTIFICATION? V— N-VCERT.N <br /> CONSUE_TANT <br /> ARE LICENSES LISTED CURRENTLY ACTIVE AND IN GOOD STANDING? YZN <br /> DO YOU HAVE EMPLOYEES? Yj[ N— <br /> If you answered NO io above, pleas* complete attached Wiver and submit with <br /> questionnaire. If YES, please provide Cerpl. (tate o! Insur nce and: complete <br /> inforrnation below. , <br /> NAME AND ADDRESS OF WORKMAN'S COMPENSATION CARRIER; <br /> NAME: 6TA- E Cdj_W f&A15-A- 7CA/ -2Aer#,chnLr-c= fu Nn <br /> ADDRESS: 11g. ADx 79fa s.IA &W-arca- Ch 95rizo-'7%�6 <br /> Leat <br /> PHONE. YO 40LA000 AGENT <br /> EXPIRATION DATE: <br /> SIGNATURE: <br /> TuT,;L P.02 <br />