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V JOAQUIN COUNTY a PUBLIC IIEAL�kI SERVICES NtYPAF('�Jy ENVIRONMENTAL HEALTH DIVISION p`,"' 304 E WEBER AVENUE a THIRD FLOOR o STOCKTON, CA 95202 209/468-3429 DEC 3 U 1997 APPLICATION ENVIRONMENTAL HEALTH PUBLIC SAN JOAQUIN CGUM;y PERMIT TO OPERATE ENVIHONNIEN1 1 HEALTH L`VISION EMPLOYEE HOUSING OR LABOR CAMP ❑New Camp ❑CoudWonal Permit ❑Annual Permit For Calendar Year 99 ❑Amended Permit ❑Multiple Years(Parmanent Haudug Camps am&) ato ADDroved —Change of Oparatar _Change of Owner ate Mailed: _(:hand*of Opar•ator•Addr*ss —Change of Owaor Address erask o 0 —Additional Employees as ID# 39-32h Please Note any Comecdtows or Ckanges In Paclld 0peratoW0%werInforsaaffaw directly on this forma ---------------------------------------------- ------------ ------ ---- -- - -- -- - — -------—------------------------•-••--------------------— --I Site Name: SAMRADO, A&SON 39-321 Location: 14000 E EIGHT MILE RD I - - ------------------------.-----------------------------------------------—----------—----------------------------------------------------------------------------------—--•.-_..-------------------------------------------! Operator: SAMBADO, A&SON INC LINDEN -....----------------•---------------- - - - -- - — ---------------- - 1 Mulling Address: 8077 N TULLY RD,LINDEN CA 95236 Facility Phone#: 209-931-2568 Legal OWUCr. SAMBADO,LAWRENCE 1e.-Owsrr 0Y N ----------------_-- Owner Address: 8077 N TULLY RD,LINDEN CA 95236 • Owner Phone#: 209-931-2568 - - ----------------------•---------------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------- -- Community Facilities Provided by Camp: Community Kltchea: ❑Yes ❑Ne Men: Number of Toilets Number of Showers Number of Lavatories Women: Number of Toilets )•Igmber of Spowers Number of Lavatories F-1q M,17 `,It'`I, CU444-Z Ilouslua Accommodations to be UtillLed this Year: Duildivas Euiuloveec Buildinr Employe Dormitories: Owner Owned MR/RV SF'Dwellings Owner Owned RR Can Apartments MII/RV Spaces TOTAL Of Both COLUMNS I [_ � 0ecu lac Da s: from t to �— L% Total Number of Days to be used this Calendar Yew, t O �P _—""- Total Days Occupied by 25 or more Employees from / /_to`/_/_ Crop NIU: snips cr:cuuea by 25 or sacra asMpkWas fur 60 or ware a,ytar require a Public Wafer Systasn Palau[ 0 Inactive Irr[po►faar: In order to protect your land use status,if camp will not be u-wd this year but Irtalendedflr use Ix fkejwtxn, Check this Box and return this appHcadox. Fee Schedule M, fib. Permanent Camp Annual Permit$35.00+Number of Employees /O @$12.00 each=$ t?i� ❑ Orchard Camp Permit Fee=$95.00 $ ❑ Transfer of Ownership=$20.00 $ ❑ Permit Amendment=$20.00+Number of Additlonai Employees g$12.00 each=$ ❑ Late Application Fee$70.00+Number of Employees Ca$24.00 each=$ Fee must be submitted with Application TOTAL FEE DUE: f S5 00 REMTr TOTAL FEE AS CALCULATED ABOVE IN THE ENCEOSED self-addressed ENVELOPE. MARE CHECKSPAYABLETO: PHSIEHD 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 tilt Em MoVEE HOUSING ACT,Chapter 1,Pert 1,Division 13 of the HOOM anti Safely Code and Chapter 1,Subchapter 3,Title 25,California Code ofReguladons. VL,V +� G t-tY 63 L- Applicant Name(pkare print or type) r Title Pre S Address 0Z1 PhonrJ0gf q_ "R _'applicant Signatur - D to of Application r Fes Amount mount Pai Do to of Pa ant Parmnt Type Reooi t i Received B ___ Empioyeo ail: 0843 Acci S.0003775 Fac ID: 004113 PR tit: 270321 PWS ID#: 5