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011::l1C11 OII• SFAIfII::VPBPIIIIrII. IIlII:AILIfIIII Ifa1I....AININIING ANII.II..)II'VII.II )II"IMII INtt <br />'�/rthl�p��y�rs •AG;:, __11 11)11::::Vll::::IlS„B aW_::.hrN"If .kVn'�a IIOIN <br />APPLICATION FOR OSHPD PREAPPROVED AGENCY (OPAA) <br />FOR STRUCTURAL TESTS AND SPECIAL INSPECTIONS <br />For Office Use Only <br />OPAA — 0042-1 ti <br />Approved Agency <br />City <br />County <br />State <br />ZIP Code <br />Kleinfelderr. Inc. <br />San Diego <br />San Diego <br />CA <br />92111 <br />APPLICATION TYPE / FEE <br />Application Type <br />New Application Fee <br />Fees are Nonrefundable <br />Renewal Fee <br />Fees are Nonrefundable <br />© Combined Testing AND Special Inspection Agency <br />'- $1.000.00 <br />® $500.00 <br />❑ Testing Agency ONLY <br />❑ $500.00 <br />❑ $250.00 <br />❑ Special Inspection Agency ONLY <br />❑ S500.00 <br />❑ $250.00 <br />APPLICANT INFORMATION <br />A1,16 nl Naiue <br />. Vu11n5I SkIny <br />Pusiliuu in IM1e Omani; aline <br />P,,-.l M.,-,:r <br />Acienny9 Loral NAmE <br />I(leinfelder, Inc. <br />Appl ICATor DAta <br />0111118 <br />Phalle NUIrDer <br />852-223-85DD <br />E-Mail <br />Istiady@kleinfeldei ccln <br />Applicant certifies that all information provided in this application are accurate. <br />Applicant signature <br />�511a <br />HnflrP.i3 nl 13Clliry LA"Lin0 (L. tlM 191r.dry LiC91)n0 /Pr1ui,Pf. f.P/)3,91P 31)1)G!.31iJrif <br />st'set <br />57111 CnplPy Drive, Suite 100 <br />Clly <br />s,, n rln <br />C-n1y <br />s-, n <br />Sln- <br />Cn <br />Z, Cud,: <br />�191 11 <br />Fatuity MAIIIng Address pf piBarent from fa%Irdy addR,SS above-) <br />Same as ahove <br />SVPP- <br />City: <br />State: <br />Zip Cade: <br />KEY AGENCY PERSONNEL(Attach additional pages ifneeded.) <br />Enginaenng Manager (of aQlrNalaOt) - Nanle <br />James L Stiady <br />CA N1 qG V91i0n N-11nEr <br />CGG243 GE2620 <br />Lxp'. r3linn ❑aIP <br />OG/3012020 <br />Tipe In pie prgpnbaTion <br />Pw,t Mnnmcr II <br />Phone Number <br />58-=23-8500 <br />FAX Number <br />n50-223-0499 <br />F-MAII <br />]sfiady@klai nfelder cam <br />Altarnate to Engineering Manager (dany)- Narna <br />Chad Da,a <br />(,A Raglstration N,nner <br />C59908 <br />Fxi) ration Dare <br />12/31/2019 <br />1 i,...lr in 1nr O«)an'.ia.inn <br />CnMET TI:-,. Leader <br />Phone Ncmber <br />H5h-22:t-85110 <br />Altarndte Phone Number <br />F-it,n I <br />cmdavu@kleinfelder cam <br />'nnl__. .0 safic_ <br />1 <br />STArE OF CALIFt W2--Yfr:AL <br />OSH-Ft]-OF'PJn;l9n (q3/Ol!?nl d) <br />d!3C?OI4 <br />AND HUMAN SERVICES AGENCY <br />rat^AA-004 )-1(; <br />tqi�i of 19 <br />