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r E� Joaquin County-Public Health Ser p,, ED t10V � � � 1-9—O Environmental Health Division � ' � [�T I .�NIE 304 E Weber Avenue-Third Floor-Stockton CA 95202-]-...j ne: 209-468-342t>�A` APPLICATION ENVIRONMENTAL HEALTH JP1N PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP 16L4Cy{FA1T�l�L �ipV1SI�N ❑New Camp ❑ Conditional Permit ❑ Multiple Years(Permanent Dousing Camps only) In Annual Permit for C�pYI� ❑Amended Permit: -Change of Operator *Change at Owner *Change or Operator Address *Change or Owner Address *Additional Employees Permit ID#: 0002951 Please Note any Corrections or Changes in Facility/Operator Information directly Camp ID#- . 39000085 Site Name: SARALE FARMS INC 39-85 Location: 1 MI SICLIFTON&CALPACK R CT,STOCKTO Operator: SARALE FARMS INC Mailing Address: PO BOX 6066,STOCKTON CA 95206 Facility Phone#: (209)943-2079 Legal Owner: SARALE FARMS INC New Owner? E]Yes ®Na Owner Address: 16500 W CLIFTON CT,STOCKTON CA 95206 Owner Phone#: (209)943-2079 Community Facilities Provided by Cama: Community Kitchen: Yes 0 No (7 faucets) Men' Number of Toilets 5 Number of Showers 6 - Number of Lavatories �1—1 5 Women: Number of Toilets 0 Number of Showers —0 Number of Lavatories ) Housing:Accommodations to be Utilized this Year: Occupancv Dates: Buildings Employees from 3I 1 Fl 0&4 1250 trop Asparagus Dormitories 415 from-1-1—to—/—/ Crop_ SF Dwellings � � Apartments 0 11 - Total Number of Days to be wed this Calendar Year 56 Owner Owned MHIRV 0 0 Total Days Occupied by25ormore Employees 56 Owner Owned RR Cars 0 0 Note: MH/RV Spaces 0 Camps occupied by 25 or more employees for 60 or more days in a year TOTALS I'�I require a Public Water System Permit. ❑ Inactive hit portant: In order to protect your land use status,if camp will not be used this year but is intended for use in the future,Check this Box and return this application. Fee Schedule permanent Camp Annual Permit Fee: 535.00+ Number of Employees 4 0 @ $1200 each=SLIL51• 0 0 Orchard Camp Permit Fee: $95.00=S ❑ Transfer of Ownership: $20.00=S ❑ PermitAmendment Fee: $20.00+ Number of Additional Employees Q $12-00 each=S ❑ Late Application Fee: $70.00+ Number of Lmployees ® $24.00 each=S Fee must be submitted with Application TOTAL FEE DUE: 5 5 15 0 0 RemitTOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-Addressed Envelope c�►aaak ` l0>s g� MAKE CHECKS PAYABLE TO: PHS-EHD Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall operated and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACC, Chapter 1,Part 1, Division 13 of tit California Ilealih and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulad ous Applicant Name THOMAS SARALE Title SEC TREASURER ❑Partnership {Please PRINT or TYPE} ❑Corporation Address P . 0. BO 6066 STO TON CA 95206 Phone 209/943._2079 Applicant Signal Date of Application 1/8/2 0 0 1 Amount Paid Date of Payme Payment Type Checkl eceipt# Received By Account ID �, 0002523 w /S. r� 1'g'D I CC - �d E-�o l7 Facility ID Program Record ID PIE Assigned to PWS ID 0002961 0270085 2755 2282-RABACA 0002951 Report C 7066.rpt ,J1)rlit� D T '" Application Printed:1117100