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01F1::1C11. DIF: FAlfll. Wllllrll. II1II.ALF1111 IF111,,,,A 11411411ING AN11,6 II,AII VII.II 4,.)1F11MII,:NT <br />f/tltd� F�A44 11'A�(CIIII 11Flll:S 11k1�:�6l�.Il..011:"IWqII'Nlf �D��V��"'b1101M <br />KEY TESTING PERSONNEL(Attach additionalpages ifneeded.) <br />Testing Su peNisor— Name <br />CA Regiatmtioil N.unber (if 9ny) <br />Expiration Date <br />Jeremy Larsen <br />I Itiv� n, m� Oir.a I7a0on <br />FrIML Nurnbcr <br />vice Pre`• CUIiIT. Matenalg Fury K I egt Illy Mnnnger <br />(9(l9) 657-17% <br />Alternate Prone Numher <br />E-Mail <br />JLaisen@Kleinfedei ccm <br />-,elo Egting SOperv.gpr— KAme <br />CIA egigtrV 01) Nnn,ber (it any) <br />rxplrntMn Onto <br />.IeIY. R,y LAISen <br />I It1P III NO om)nlcleon <br />Phone Number <br />Virc Pic, Con,,L Malcri:ds Erg 5 Test Div Manager <br />(909) 657-1716 <br />Allemol_ Pnw,c NLi„bcr <br />r-u¢.lI <br />J Larsc ntC�Kldnfddc r-com <br />KEY SPECIAL INSPECTIONS PERSONNEL (Attach additional pages if needed.) <br />$p9Pa1 ,6119GIunS SupeNgor— Nwne <br />CA Registrat or NO tuber (if ally) <br />Expiration Date <br />J9r9.ny I arsyn <br />Title in the urga Ibatli;n <br />Friona Number <br />Vice Preg CpngT. Mnter.nlg Fnq_ .Y I eat Illy Manager <br />(909) 657-1716 <br />Alternate Pnons Number <br />E-Mail <br />J1 Arsen@kleinfler r.cm <br />FiEld SremAI llS,I C.rt I SIIOeNISOr— NAmE <br />CA R"i,,trAt'.or N'.ITber (if.eny) <br />EXPIWATior DAtE <br />Jernnly Larsen <br />Title In the Organization <br />Phony Numher <br />VIeC Pmg Collo't- Matorl:alg Lng- 3 1 r`gt DIV Mallagcr <br />(yp9) 5J/H-1 /l h <br />Altpnntc Pnunc Numb,, <br />F-n,n I JI an, <br />I <br />STATE OF CALIFt M9-- rMN1 <br />U"A i-FLD-r WAA- 100 (G/2-1{"'pi eS) <br />_VZ V >017 <br />AND HUMAN SERVICES AGENCY <br />0PAf\-0010-1I' <br />