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CONT TOR/CONSULTANT QUESTIONNA <br /> t, UBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388 STOCKTON CA 95201-0388 <br /> OWNER INFORMATION <br /> BUSINESS NAME: <br /> Pacific Excavators <br /> ADDRESS : <br /> P.O. Bog 966 <br /> CITY/STATE/ZIP: Alamo, CA 94507 <br /> PHONE NO (510 ) 370-8783 PHONE NO 2 ( ) FAX NO (510 )939-9044 <br /> OWNER #1 INFORMATION OWNER #2 INFORMATION <br /> NAME: NAME: <br /> Rita Mendez <br /> ADDRESS : P.O. Box 968 ADDRESS: <br /> CITY: Alamo, CA 94507 CITY: <br /> STATE: ZIP: STATE: ZIP : <br /> LICENSE INFORMATION <br /> CA CONTRACTOR LICENSE DATE ISSUED 11 / 1 /go EXP DATE 10 /31 /96 <br /> LICENSE CLASS 1 LICENSE CLASS 2 LICENSE CLASS 3 <br /> "C" SPECIALITY #` S <br /> A 5453 <br /> TYPES OF LIMITED SPECIALTY(IES) Hazardous Waste Removal and Remedial Certification <br /> LICENSE IN GOOD STANDING? Y/ N WORKERS COMP INSURANCE Y <br /> WORKERS COMP INSURANCE CERTIFICATION ON FILE WITH E.H.D. ? Y N <br /> EXPIRATION DATE <br /> HAZARDOUS WASTE CLEAN UP CERTIFICATION? �D N see above <br /> CONSULTING FIRM NFORMATION <br /> SITE MITIGATION CONSULTING FIRM? Y N) _ SAMPLING FIRM ONLY? Y <br /> CA REGISTERED OR CERTIFIED GEOLOGIST/ENGINEER? Y N <br /> PRIMARY QUALIFYING INDIVIDUAL: <br /> GEO/ENGINEERING REG/CERT NUMBER: <br />