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CE VED NOV .2 7 1 99 h-Ve "_."AN JOAQUIN COUNTY • PUBLIC HEALTH $iti. `CB5 �y/� �� r ENVIRONMENTAL HEALTH DIVISION P/"4itrl / 304 E WEBER AVENUE : THIRD FLOOR a STOCKTON CA 95202 • Phone: 209/466- D APPLICATION JAN ; ENVIRONMENTAL HEALTH 3 2000 PERMIT TO OPERATE pusr ,�trH sEHI ��. EMPLOYEE HOUSING OR LABOR CAMP FNV'A0NMFNrA1_ r_Ttt ❑Now Camp ❑Conditional Permit 16nnai Permit For Calendar Year ❑Amended Permit ❑Multiple Years(Permanent Housing Camps only) ata Approved + • Change of Operator *Change of Owner ate Milled: • Change of Operator Address Change of Owner Address ermit# 002951 • Additional Employees lampID# 39000085 Please Note an Correcdons or es In F /0eralar�owner I or►rmOn direr on this form. Site Name: SARALE FARMS INC 39-85 Location: MI S/CLIFTON 8c CALPACK R CT Operator: SARALE FARMS INC Mailing Address: PO BOX 6066, STOCKTON CA 95206 Facility Phone#: 209-943-2079 Legal Owner: SARALE FARMS INC �N we Owner ❑Yes ❑ Owner Address: 16500 W CLIFTON CT,STOCKTON CA 95206 Owner Phone#: 209-943-2079 ' Community Facilities Provided by Camp: Community3atchen: ❑Yes ❑No (7 faucets) Men: Number of Toilets 5 Number-ofshowers 6 Number of Lavatories 1 —1 5 i Women:Number of Toilets 0 Number of Showers 0 Number of Lavatories 0 Housinp,Accommodations to be Utilized this Year: Bnlldinss Emcees BaUdingl Era lOo ces- Dormitories: 4 15 EACH Owner Owned MH/RV U' U SF Dwellings ____2_ __3U_ Owner Owned RR Cars Apartments 0 Spaces e TO'T'AL of Both COLUMNS Occupancy Dates:. from 3/ 1 10 0 to 4125/ 0 0 Crop ASPARAGUS Total Number of Days to be used this Calendar Year tYnm Crop Total Days Occupied by 23 or more Employees _/_/_to_/_/_ Note: Camps occupied by 23 or mare employees for 60 or mon days a ytar requi re a Pmbllc i3'ater System Per=u ❑ inactive In order toprotectyour land use status,ifeamp will not be umd 04syear bid isfntem4edfar ore in t%ejk&Am Cheekthis Bas and return this apptfeatk . - _ 3'ee Schedule Permanent Camp Annual Permit$35.00+Number of Employees 40 $12.00 each a$ 51 5.0 0 ❑ Orchard Camp Permit Fee=$95.00=$ ❑ Transfer efOwnership=S20.00=S ❑ Permit Amendment=$20.00+Number of Additional Employees @$12.00 each=$- ❑ Late Application Fee$70.00+Nnmber of Employees @2-4.00 each=$ Fee must be submitted with Application TOTAL FEE DUE: 515 -0 0 REMIT TO'T'AL FEE AS CALCULATED ABOVE IN THE EN LOSED self addressed ENVELOPE. M4AF CHECKSPAYABiETO. PHS/EHD Applicant agrees to all necessary inspections Incident to issuance of a PERMIT To OPERATE. Applicant agrees that this project(camp)shall be operated and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT, Chapter 1,Part 1,Division 13 of the Health and Safety Code and Chapter 1,Subchapter 3,Title 25,CaUfornta Code ofRegulaftons. Applicant Name THOMAS SAKALE Title—SEC. /TREAS.❑Partnercldp'NCo"rporadou (PteasePRlNlor?7PE) Add s BOX ockton CA 95206 Phone 209/943-2079 Applicant Signature Date of Application 01 /12/2000 Program Recorde 270055 Facility ID# 1)02961 Account ID# 0002523 AMWt Paid Dft a t t## Recciv r Employee* Atct it fele ID: PR 9. PM 1D#: P '� U V7 5 Z8