COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

San Joaquin County-Environmental Health Department 1868 E Hazelton Ave-Stockton CA 95205-Phone: 209468-3420 APPLICATION ENVIRONMENTAL HEALTH PERMIT TO OPERATE EMPLOYEE HOUSING OR LABOR CAMP ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ® Annual Permit for Calendar Year 2026 ❑ Amended Permit: *Change of Operator *Change of Owner *Change of Operator Address *Change of Owner Address *Additional Employees State ID#:39-0321-EH Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: A SAMBADO&SON 39-321 Location: 14000 E EIGHT MILE RD LINDEN Operator: A SAMBADO&SON 39-321 Email: Mailing Address: 8077 N TULLY RD,LINDEN CA 95236-9619 Facility Phone#: (209)931-2568 Legal Owner: SAMBADO,LAWRENCE J&BEVERLY New Owner? ❑ Yes No Owner Address: 8077 N TULLY RD,LINDEN CA 95236-9619 (hvnrr['hone#: (209)931-3086 Email: Community Facilities Provided by Camp: Community Kitchen'? ❑ Yes ❑ No Men: NumberofToilets ��` Number of Showers Number of Lavatories Women: Number of Toilets Number of Showers Number of Lavatories Housine Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees / Dormitories from e//62�/p,4 to /h�/ tl ��d Crop SF Dwellings from / / to / / Crop Apartments / Owner Owned MH/RV /Zj Total Number of Days to be used this Calendar Year: v Owner Owned RR Cars �— Total Days Occupied by 25 or more Employees: MH/RV Spaces Note TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year Require a PUBLIC WATER SYSTEM Permit ❑Inactive Important: In order to protect your land use status,if camp will not be used this year but is intended for use in the future,Check this Box and return this application. Fee Schedule �� Permanent Camp Annual Permit Fes $54.00+ Number of Employees Lf� @$17.00 each=$ ❑ Transfer of Ownership $25.00=$ ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ Fee must be submitted with Application TOTAL FEE DUE$ Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed Envelope MAKE CHECKS PAYABLE to 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 California Health and Safety Code and Chapter 1,S chapter 3,Title 25,Cali nin Code ofRegidafions. Applicant Name Title �G` ��`j - ❑Partnership (Please PRINT oXyo��l Address 441 % j� t o 9�Q1 Phone Applicant Signature Date of Application Amount Paid Date of Payment Payment Type Check/Receipt# Received By Facility ID Program Record ID P/E Assigned to PWS ID I_10004113 PR027031_1 Aaron Gooderham Report#:7067.rpt RECEIVED !OEC 2 2 2025 > iun.�uw cuuri;