Laserfiche WebLink
PtttC HEALTH MVICES <br /> O,Oulry <br /> ...... <br /> SAN JOAQUIN COUNTY r. <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> P.O.Box 2009 (1601 East Hazelton Avenue) • Stockton,California 95201 <br /> C4�iF<1'R� P <br /> (209)468-3400 <br /> e <br /> RE: CALIFORNIA LICENSED CONTRACTOR QUESTIONNAIRE <br /> In order to comply with State and Local Laws relative to contractor <br /> licensing and Workman's Compensation Insurance requirements, we are asking <br /> that you provide this District with the information requested below. <br /> Please answer all of the questions and return the original of this letter <br /> to Public Health Services Environmental Health Division. <br /> Ron Valinoti, Director <br /> Environmental Health Division <br /> BUSINESS NAME LAWRENCE LIVERMORE NATIONAL LABORATORY <br /> BUSINESS ADDRESS 7000 East Ave. CITY Livermore ZIP 94550 <br /> BUSINESS TELEPHONE (1) _(510) 422-1100 (2) (510) 422-0649 <br /> OWNER #1 U. S. Government, D. 0. E. OWNER #2 <br /> ADDRESS 1301 Clay St. - Oakland, CA 94612 ADDRESS <br /> PHONE NO. (510) 637-1794 PHONE NO. <br /> CA. , CONTRACTOR LICENSE NO. N/A ISSUE DATE N/A EXP DATE N/A <br /> LICENSE CLASSIFICATION (A, B, C) N A IF "C" INDICATE SPECIALTY NOS. N/A <br /> IF "C-61/1 CLASSIFICATION, INDICATE TYPE/S OF LIMITED SPECIALTY/IES NZA <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD STANDING? Y N <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA,, DO YOU <br /> CARRY WORKMAN'S COMPENSATION INSURANCE? YES NO X <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WITH THIS DISTRICT? Y N <br /> IF YES, EXPIRATION DATE <br /> SIGNATURE <br /> TITLE Tank Upgrade Project Manager <br /> DATE 8 August 1993 <br /> A Division of San Joaquin County Health Care Services <br />