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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 Employes State ID#: Please Note any Corrections or Changes in F•acilifylOperator Information directly oil this form. Site Name: STERLING FARMS LLC Location: 22220 N IIWI'99 ACAMPO Operator: STERLING FARMS LLC Email: Mailing Address: 17250 E KETTLEMAN LN,LODI CA 95240 Facility Phone#: (209)401-5177 Legal Owner: BURNETT,TODD New Owner? ❑ Yes No Owner Address: 17250 E KETTLF.MAN LN,LODI CA 95240 Owner Phone#: (209)401-5177 Email: Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No Men: Number ofToi lets NumberofShowers 2 4 1 TL)6 Number ofLavatorics 3 Women: NumberofToilets Number of Showers Number of Lavatories flousina Accommodations to be Utilized this Year: Occupancy Dates: Buildines Emplavees Dormitories from /il / 2 to , / 3112 b Crop Lif VfSreC k /{A SF Dwellings ' from / / to / / Crop Apartments _ Owner Owned MH/RV Total Number of Days to be used this Calendar Year: 30 S Owner Owned RR Cars Total Days Occupied by 25 or more Employees: —�— MH/RV Spaces Note TOTALS Camps occupied by 25 or more Employees for60 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 die future,Check this Box and return this application. Fee Schedule pS Permanent Camp Annual Permit Fee S54.00+ Number of Employees @$17.00 each=$ O �•u� ❑ Transferof Ownership $25.00=$ ❑ Permanent Amendment Fee S25.00+ 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,FETE as CALCULATED ABOVE in the ENCLOSED Self-addressed Envelope MAKE CHECKS PAYABLE:to EIID 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,Subchapter 3,Title 25,California Code of Regulations. A LI M Itep LI A 8l LI Ty Applicant Name ,—��A C gU R lJt~-7T" Title ❑Partnership 11 PAN Y (Please PRINT or TYPE) ❑Corporation Address 17z D E , k-c-TrLEMAri LP Lp�Iol CA qs 2-yo Phone Zp of —5-1-7 Applicant Signature = _/= 0 � Date of Application t 1 to Amount Paid Date of Payment Payment Typethe! eceipt# Received By I? . - 11 25 3--3 Facility ID Program Record ID PIE Assigned to FA0027372 PRO547994 765 Aaron Gooderham Report#:7067.rpt NOV 0 4 2025 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT