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PAYMENT <br /> Rece <br /> VED <br /> San Joaquin County-EnrlrontnenlalOtollbDepartment MAY 23 2018 <br /> IME.NhrtltouAtenue-Slocktnu CA 9SID.A-Phmnt: 209.469•3420 v (I <br /> 8AN JOA <br /> RONMF UNTV <br /> ar..tlm.nort HEALTH O N7 NT <br /> LNl'tRON\IE.NTAL tIF t TH <br /> PERMIT TO OPERATE EFgRNE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> 1MCtaaP ❑faadltfa.al Pttash �]}[aklplel'etmt lPersmnnt Houdpt Cacpt eatyl ®Aoornl Permh t'a Cakadartirn 2018 <br /> C3Ar+atltd iMtrdt: •('Late epOpe»ta '(!ante efOst�r <br /> `C11ate.f(tperator Addms 'C'haate.r Oa Address Ptrmlt 1Da: <br /> •AddMotul EutpAoye.t •- <br /> Slate M si: <br /> EII ID A: <br /> Pltvate tiok'dm•Cartvtdons or Chdtt ns in FnriJiN' tvrorTnjOrmatfon dlrcctls ox Chir roan. <br /> sth.N'~ AMERICAS BEST VALUE INN-STOCKTON L.ritiew 3951 Budweiser Ct.Stockton,CA 95215 <br /> optraror:FRESH HARVEST INC <br /> ]Iaitintwa3,�a 101EMAIN ST,HESER.CA.92249 200-03 -0345 <br /> Lepel Owner. MEERAN KHUSAL N.tr Onner' ❑yes ❑t'io <br /> Ow Addresu 3951 Budweiser Ctt Stockton,CA 95215 Owns Ph...a:209382-5361 <br /> C.umaolty Farffitks 1'ros4drd by Cama: Com a mitt'Kitchen^ ❑YeS ® No <br /> M.a: N'smrher oFTalea 30 Numl-f5b— 30 Nteml-.M.,wories 30 <br /> R'onea: Nrmsic o17-1.a s Number of Showers V riber of L-rories <br /> Hertsfae Atremmedatloat to 61 Ulitlred tbis Year: Ocml'a*fr Dates: <br /> B.MmU Employees <br /> Dxmir- 120 from 07:01;2018 to 10 01;2018 erep GARLIC <br /> ST Daslhnp fvm_'_%_to—'—' Crop <br /> Apar- <br /> 0.-O%-td 2.111-Rt' Total Nmnber of"Days to be med this Calendar fear: <br /> pave Owvcd RR Cas Total Days Demote!by 23 or more Employ- <br /> TOTA1S120 r,..Pt o-pled.by 25 w more Luphey-m for 60 or mare dais a.)vu <br /> Requh a FL'BUC Tt:ATER SYSTE,%1 Permit <br /> ❑Inatifce <br /> Imoorta.t:7a adrr oo profess yssm hod nsc mms.irmap a;n mt Lc urn Chit yar bu is imrodt�fosse is t6c Aare.CTrcY this Bmc and tehaa X46 aPPacaam. <br /> Fee Schedule <br /> ® P rm_r�CaatpdncoalPamitFr. SSO.OD- VmnbrsofEmploy- 120 n S13.o0eatb=S 1.850 <br /> Q Tramfer of Oa leap 525.00-S <br /> ❑ ?crmsacvr Amcadarem Tee <br /> S25.00- Number of Additional Employm <br /> ❑ tare Appltarioa Fre 5100.00+ Number of Employees 6t 330.00 eatb=S <br /> Fee most be submitted witb_appllratiou <br /> TOTAL FEE DVE S 1,850 <br /> Retail TOTAL FEE as CALCULATED.ABOVE M the ENCLOSED 5#117-adeewd E-0.p. <br /> y1-kKI CHECKS P.AI".iBLE ro EHD <br /> r Appliraat >Lrtc, to all aecei-a m,ped- incldmt to -uance of a PERMIT IO OPER.ATI. Applicant atrees that chis prgxt (tamp) shaB be oPet At.d <br /> and maotamei is accoedauce pith the applicable p-...... of the EMPLOYEE 1101SISG ACT, Chapter 1, Par) 1, Di,W.. 13of the Cnhf-i. H. hh <br /> nxJ.Tolar Cod and C Wpter].Subchapnr},716•_i,Cnfifnnrin(nd�n/Rrpulanan. <br /> Applicant Name ADRIAN GURROLA Title HOUSING COORDINATOR ❑' """`I`u' <br /> i:rr:.Pill:17'PEt ❑1.tn�Yai1M <br /> Address 101 E WIN ST.HEBER.CA 92249 Pbpde 760 352 2364 x 151 <br /> Appitcant Sf2natorr '---- Darr of Application 0 - 1-7 ZQ� <br /> A—P.W U.W of Pay,nnit P.ytnunt Typo Ch. .ealpt 0 Deceived DY Accrsrnt ro <br /> �saed 46I2-Z <br /> ��F c4lry I//D Program RRa//ced 10 PIE AS%VwA to Pws ID <br /> CO <br /> if�pdti.7066 AppYntiM Penial 61158019 <br />