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ENVIRONMENTAL HEALT I DEPARTME <br /> SAN JOAQUIN COUNTY Unit SuperLiwrs <br /> Donna K.Heran, . .H.S. Carl Borgman,RE.H-S- <br /> RE <br /> 304 East Weber Avenue, Third Floor Mike Huggins,R.E.H.S.,RD.1. <br /> Director <br /> Al Olsen,R.E.H.S. Stockton, California 95202-2708 Douglas W.Wilson.R_E.H.S. <br /> • �.. �P• Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H-S. <br /> 4i+F6 <br /> RS Laurie A.Cotulla,R.E.H.S. 7 4b4-0138 Robert McClellon,R.E.H.S- <br /> g <br /> Pro ram Manager <br /> Fax: ( �) Mark Barceilos.R.E.H.S. <br /> CERTIFICATE OF NON-OPERATION <br /> NOTICE: Health and Safety Code Section 17037.5 requires any person ceasing <br /> to operate or maintain employee housing to annually file a <br /> Certification of Non-Operation with the enforcement agency for two <br /> (2) years following the discontinuation. Section 97037.5 is reprinted <br /> I <br /> on the reverse side of this page. For additional information tail the <br /> Department at (996) 445-9471. <br /> t <br /> Certificate for Calendar Year.2004 Employee Housing Facility LD. No. 39- 0 0 0 0 8 5 <br /> Employee Housing Facility Name Saral e Farms Inc . , 39-85 - <br /> Address 1 Clifton Ct . Rd . , Stockton <br /> 95206 <br /> Operator Name &Address Sara 1 e Farm n P <br /> k$ Telephone Number 209/94 -20 <br /> property Owner Name&Address Main Stone Corooration 293Q White a e D Merced <br /> CA 95340 <br /> Reason for Discontinued Operation (Check as appropriate) <br /> k <br /> property Sold To: on: <br /> t Housing Destroyed(Date): <br /> X Housing Facility soil exists, but will not be occupied by any employees any part of the year. <br /> Facility will only be occupied by^(less than 5)employees during the calendar year. <br /> l <br /> I ^, Other,or explanations: <br /> i Maximum number of employees who have or will occupy the facility identified above during the calendar <br /> f year <br /> Certification: L .Thoma s S a ..a I v.- - as <br /> . � (Print Name) ��} <br /> - ....-... .- ed'herein is true and correct to the best <br /> certify under'penalty of ry that th6 fnfb trop proved <br /> of my knowledg <br /> ` Date Fe <br /> { Signature <br /> �,t* <br /> ' MAR 1 1 2004 <br /> 4 <br /> ENVIRONMENT HEALTH <br /> (.COWS PERMIT/SERVICES <br />