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WWI <br /> PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D.,M.P.If. <br /> Ileahh officer <br /> Y.U. [lux 2009 . (1601 fast Ilazeleon Avenue) Stockton,California 95201 c�Fo•'-'' <br /> (209) 468-3400 <br /> Gi q <br /> RE: CALIFORNIA LICENSED CONTRACTOR QUESTIO <br /> In order to comply with State and Local Laws relative to contra l " ted <br /> Workman's Compensation Insurance requirements, we are asking t �,, rKvi ilis <br /> Department with the information requested below. Please answer all of tli 11 tions and <br /> return the original of this letter to Public Health Services Environmental F altf6Division. <br /> Ron Valinoti, Director <br /> Environmental Health Division <br /> BUSINESS NAME Spectrum Exrloration Inc <br /> BUSINESS ADDRESS 15375 Barranca Parkwa)CITY Irvine _ZIP 92718 <br /> BUSINESS TELEPHONE (1X714)753-1408 (2) <br /> OWNER #1 OWNER #2 <br /> ADDRESS ADDRESS <br /> PHONE NO. PHONE NO. <br /> CA., CONTRACTOR LICENSE NO. 512268 ISSUE DATE6/87 EXP DATLO/30/83 <br /> LICENSE CLASSIFICATION (A, B, C) c IF "C" INDICATE SPECIALTY NOS.— <br /> C-5 7 <br /> OS._c-57 <br /> IF "C-61" CLASSIFICATION, INDICATE TYPE/S LIMITED SPECIALTY/IES <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? YESL—NO_ <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE WPI'I•I THIS <br /> DEPARTMENT? YES_Y NO IF YES, EXPI -PIOND TE 9/1/91 <br /> SIGN R <br /> TITLE 2sc <br /> DATF 4-14-(Il <br /> l:ll 00 09 <br /> A Division of S+n Jumpiin County I kiitIi fere Scrvikcs <br />