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San Joaquin County-Environmental Health Department <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ❑Annual Permit fur Calendar Yom <br /> ❑Amended Permit: sChange of Operator "Change of Owner <br /> 0026139 <br /> Permit ID—- -�� <br /> :Change of Operator Address 'Change of Owner Address P #• <br /> "Additional Employees —� <br /> State]D#: -� <br /> EH ID#: <br /> Please Note aiQCorrections or Clwngesiil lacliht}t% tor Infornwhon rltr'eedro r thisform. <br /> Site Name: FRESH HARVEST INC Location: 3951 BUDWEISER CT,STOCKTON <br /> Operator: MENDOZA,MARIA <br /> Mailing Address: 101 E MAIN ST,HEBER CA 92249 Facility Phone#:(209)931-9341 <br /> Legal Owner: KHUSAL,MEERAN New Owner? ❑Yes I✓ No� <br /> Owner Address: 101 E MAIN ST,HEBER CA 92249 Owner Phone#:(760)352-2364 <br /> l:ommunimFakilitiesPtpvidettbyC:Amn: Community Kitchen? ❑ Yes QNo <br /> Men: Number of Toilets 0 NumbcrofShowers 0 Number of Lavatories 0 <br /> Women: NumberofToilets 65 Number of Showers 65 NumberofLavatories 65 <br /> Housine Accommndatians to he Utilized this Yenr: Occupancv Dates: <br /> A-01—dim t:mplovm <br /> Dormitories 65 260 frorn 06/25 ,2022 to 09/_22/ 2022 Crop GARLIC <br /> SF Dwellings from_r / to / 1 Crop <br /> Apartments <br /> Owner Owned MH/RV Total Number of Days to be used this Calendar Year. 89 tt It C <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: 89 T lWtNT <br /> MH/RV Spaces Spat RECEIVED <br /> 260 Camps occupied by 25 or more Employees for 60 or more days in a year MAY 1120 , <br /> TOTALS F6 5Require a PUBLIC WATER SYSTEM Permit <br /> ❑Inactive sA N JOAOUIN COUNTY <br /> lin Ilgrtan• In order to protect our land use status,if cam will not be used this ear but is intended for use ur the future,Check this Box and return this application ENVIRONMENTAL <br /> _-_L�--.... P Y P T pp ��A ETH DEPARTMENT <br /> FPP Schedule <br /> ElPermanentCamp Annual Permit Fee 550.00 i. Nuin'oer of Employees 260 Gal S 15.00 each=S $3'$40'00 <br /> ❑ Transfer of Ownership S25..00=S <br /> ❑ Permanent Amendment Fee S2500+ Number of Additional Employees rCt S15.00 each=S <br /> ❑ Late Application Fee $10000+ Number of Employees @)530.00 each=S <br /> Fee must be submitted with Application <br /> TOTAL PEE DUE 5 $3,840.00 <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed Envelope <br /> i MAKE C ECKS PAYABLE to EHD <br /> r <br /> Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project (camp) shall be operated <br /> and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT, Chapter 1, Part 1, Division 13 of the California Health <br /> and Safely Code and Chapter 1,Subehapter 3,Title 25,California Code ofRegalanons. <br /> Applicant Name ADRIAN GURROLA Title HOUSING COORDINATOR ❑Partnership <br /> (Please PRINT or TYPE) ❑Corporation <br /> Address 101 E MAIN ST, H BER, CA. 249 Phone 760-996-2252 <br /> Applicant Signature Date of Application 0<142a ZZ <br /> Amount Paid ate of Payment Payment Type Check/Receipt# Received By Account ID <br /> 3 7'v 0046122 <br /> Faculty ID Program Record ID v PP!F l_` Assigned to PWS ID <br /> FA0024661 PRO543451 S^, 1420-NISSIM N/A <br /> Ret'at#.7066 Application Printed:'11/1912020 <br />