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POAQUIN COUNTY a PUBLIC HE,AL .RVICES <br /> ENVIRONA'IENTAL HEALTH DIVISION <br /> 304 E WEBER AVENUE* THIRD FLOOR* STOCKTON, CA 95202 <br /> 209i468-3420 MAR 19 1998 <br /> APPLICATION .,rt,QUutq'1v <br /> yogi st. <br /> bN 5�5r' ENVIRONMENTAL HEALTH j�U$l.,c HLiZ rH yl•t1VICES <br /> PERMIT TO OPERATE �� �tpNAAEN'f�11 rIEA.TH DIVISION <br /> EMPLOYEE HOUS-ING OR LABOR CAMP <br /> Now Camp u Conditional Permit Annual Permit For Calendar Year 199 <br /> ❑Amended Permit ❑Multiple Years(Permanent Housing Camps oxiy) ate roved <br /> —[::Lange of Operator —Change of Owner Date Mailed: <br /> —Change of Operator Address —Chunµe of Owner Address Permit a 0014621 <br /> —Additional Employees jCamp ID i# 39-17( <br /> Please Note any Corrections or Changes in FacihWOperutor/Orvner InfbrmiWan directly on this form <br /> ---- - —------------------------------------ = ---- -- -- -- - — --- — - - ------------------------------------------- -- <br /> Site Name; VERNON GOGNA 39-176 Location: 13959 E FANNING RD 1 <br /> -----------------------------------------------------------------—---------------------------------------- 1 <br /> Operator: GOGNA,VERNON STOCKTON <br /> +-----------------------------------------------------------------------------------------------------------------------— ------- - — ----------------------- <br /> 1 Matting Address: 13959 E FANNING RD, STOCKTON CA 95215 Facility Phone#: 209-931-4392 I <br /> Legal Owner: GOGNA,VERNON $ew Owner ❑Yes XXNq <br /> --------------------------------------- — -—--—--- —- - -- - - -- - <br /> ----- ---- --- <br /> �'I Owner Address. 13959 E FANNING RD, STOCKTON CA 95215 Owner Phone#: 209-931-4392 <br /> -- ------- - --- ------- -- ------------------------------------ I <br /> Lp�munit FaC�tles Pror7deu by Cam Community Kitchen: u Yes L No <br /> Q Namber of Toilets Number of Shower Number of Lavatorteit <br /> a omen rmber of Toilets Number of Slwwers Number ofL-acalories <br /> od'Ai011stobeUtlllzed this Year: <br /> j' usin Ac'� E �s s„++atsios Employees <br /> ua I Owner Ow ned NI11/11 V <br /> D��DCIZs �— Owner Owned RR Cars <br /> MURK-Spaces <br /> p:aIIiugs Torsr,of Both CoLixDos , i I <br /> menu � <br /> I �� Y ttn�e�• Total Nambber of Days to be used this Calendar Your <br /> / 1 C-1 ToW Dup Occupied by l5 or more r mpioyees <br /> Cro dote s oec ed b 23 or more a ti't �r 60 or more dos a year <br /> 1 /---- p �= �dA � Y +�03 J <br /> rrom_/_/—to—— regture a Pablie PhWr System Perrin <br /> t be uwd this voar but Is intended for use In the fttrarc,Check thin Bos and return <br /> rlale In order to p <br /> 0 Inactive rmAo <br /> this appNndim+- e(iule <br /> �1l <br />