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Z1UB.,.jlk_.j HEALTH SEM/ ,(.ES DEC 0 8 1994 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH PERMIT/SERVICES p O Box 2009, Stockton, CA 95201 445 N. San Joaquin, Stockton (209)468-3420 CERTIFICATION OF NON-OPERATION ::: ... ................................. .................................................................... . ....... ........:::............................................................ .... ............................................................ NOTICE: Health and Safety Code Section 17037.5 requires any person ceasing to operate or maintain employee housing to annually file a Certification of Non-Operation with the enforcement agency for two years following the discontinuation. Section 170375 is reprinted on the reverse side of this page. For additional information call the Department at (916) 445-9471. .................... Certificate for Calendar Year /995 Employee Housing Facility LD. No. Employee Housing Facility Name V< Pe¢. END-" S — Ca,-� y-- Address CAµp 4 PJ AS!; u 'Z>70CK-&Q , eA G<po f$ Operator Name K4'�)� F+ao.r is Address 34 > -�h9C Tit t C-&, q c10 Telephone No. fo1oG� �6`{-14-19 Property Owner Name _Det_m VEL-rte i✓ns Address 36g7 r-t-r jao F5t p��v D --T6- 32t� lama &ala E aA q 4 s�5 Reason for Discontinued Operation (Check as appropriate) ❑ Property Sold To: On: ❑ Housing Destroyed (Date): ❑ Housing Facility still costs, but will not be occupied by any employees any part of year ❑ Facility will only be occupied by _ (less than 5) employees during the calendar year ❑ Other, or explanations Maximum number of employees who have or will occupy the facility identified above during the calendar year CextiIIc tion: L as _r +•• •.ct�e_ T�a.t ywa�l MTLv, cerrify under penalty of perjury that the information provided here:n is true and correct to the best of my knowledge. Signature /c-/( Date 5-