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�i AND DEVELOPMENT <br />OFFICE OF STATEWIDE HEALTH PLANNING <br />hl FACILITIES DEVELOPMENT DIVISION <br />7 TEST TECHNICIANS <br />Provide Following Information for Each Test Technician Employed by the Agency (Attach <br />additional sheets if needed) <br />*To update expiration date a renewal application for CIPAA and proof of renewal for certificationAicense shall be required <br />Test Technician's <br />Certification) <br />Certification/ <br />Certification/ <br />Expiration Date* <br />Comments <br />Name <br />License Type <br />Licensing Agency <br />License Number <br />NICET LEVEL III <br />NICET <br />129413 <br />06-01-19 <br />Soils <br />NICET Level III <br />NICET <br />129413 <br />06-01-19 <br />s halt <br />NICET Level III <br />NICET <br />129413 <br />06-01-19 <br />Michael Magana <br />Concrete <br />ACI <br />01112801 <br />12-20-21 <br />Updated since DSA App <br />CI Aggregate <br />CI Field Testing <br />CI <br />01112801 <br />03-17-17 <br />ech <br />CI Strength <br />CI <br />01112801 <br />08-13-19 <br />estin Tech <br />Caltrans - Soils <br />Caltrans <br />Na <br />1-31-19 <br />Updated since DSA App <br />Updated Since DSA <br />Michael Magana <br />Caltrans - Concrete <br />Caltrans <br />Na <br />12-2-18 <br />PP <br />Caltrans- Asphalt <br />Caltrans <br />Na <br />9-17-17 <br />Mario Sanchez <br />CI Strength <br />CI <br />0138403 <br />11/10/21 <br />estin Tech <br />CI Field Testing <br />CI <br />na <br />5-12-17 <br />Eric Finley <br />ech <br />HMA / SOILS / PCC <br />Caltrans <br />Na <br />12-31-17 <br />CI Field Testing <br />CI <br />Na <br />12-14-18 <br />Tech <br />EdmondJabbour <br />ACI Strength Test <br />CI <br />Na <br />11-14-18 <br />Tech <br />HMA / SOILS / PCC <br />Caltrans <br />Na <br />1-31-19 <br />Curtis Bullis <br />CI Field Testing <br />CI <br />Na <br />3-17-17 <br />ech <br />ClFieldTesting <br />CI <br />Na <br />1-17-20 <br />Dominic Montemayor <br />ech <br />Soils / PCC <br />Caltrans <br />Na <br />5-9-17 <br />Cl Field Testing <br />Cl <br />00988756 <br />3-16-18 <br />ech <br />Thomas Rebosky <br />ICC Soils <br />ICC <br />B083156 <br />10-18-19 <br />Soils, Concrete <br />NICET <br />130583 <br />10-1-2019 <br />s halt <br />Jeffrey Diaz <br />Soils, Concrete, <br />Caltrans <br />na <br />arious <br />s halt <br />Reinforced Conic, Mas, <br />ICC <br />5320836 <br />2-07-2018 <br />Fire roofin , Soils, <br />Ani IU.IfA <br />ACI <br />01074782 <br />Various <br />"Access to Safe, QualllV Healthcare Environments that Meet Callfomla's Diverse and Dynamic Neetls" <br />(th m OSH PD <br />STATE OF CALIFORNIA — HEALTH AND HUMAN SERVICES AGENCY <br />OSH-FD-OPAA-100 (612412016) Page 10 of 19 <br />3/28/2017 OPAA-0010-16 <br />