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San Joaquin County-Environmental Health Department PAYMENT 1868 E Hazelton Ave-Stockton CA 95205-Phone: 209468-3420 RECEIVED APPLICATION DEC 16 2025 ENVIRONMENTAL HEALTH PERMIT TO OPERATE SAN JOAQUIN COUNTY EMPLOYEE HOUSING OR LABOR CAMP ENVIRONM�� ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ® Annual PermitNEALTWE)EPIex`iIYIENT ❑ Amended Permit: *Change of Operator *Change of Owner *Change of Operator Address *Change of Owner Address *Additional Employees State ID#:39-0322-EH Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: VAN GRONINGEN&SONS 39-322 Location: 14225 E FRENCH CAMP RD RIPON Operator: VAN GRONINGEN&SONS 39-322 Email: h-.;X1.0 (S Mailing Address: 15100 S JACKTONE RD,MANTECA CA 95336 Facility Phone#: (209)982-5248 Legal Owner: VAN GRONINGEN&SONS New Owner? ❑ Yes No Owner Address: 15100 S JACKTONE RD,MANTECA CA 95336 Owner Phone#: (209)982-5248 Email: P"Wes Provided by Camp: Community Kitchen? V Yes ❑ No Men: Number of Toilets 3 Number of Showers 3 Number of Lavatories f Women: Number of Toilets Number of Showers Number of Lavatories Housing Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees Dormitories �L{ from /01/ZIP to/2•/? / 0Z(0 Crop MOL1� SF Dwellings from / / to / / Crop Apartments Owner Owned MH/RV Total Number of Days to be used this Calendar Year: Owner Owned RR Cars Total Days Occupied by 25 or more Employees: MH/RV Spaces Note TOTALSCamps occupied by 25 or more Employees for 60 or more days in a year 2 L( 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 Fee $54.00+ Number of Employees L( @$17.00 each=$ 7 D R, D ❑ 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,Subchapter Title 25,California Code of Regulations. Applicant Name SOL. Title Sq �Qyla,p,t,,r ❑Partnership (Please PRINT or TYPE) - (( � ^ e �- corporation Address is O a S. �wc�lE.Te rt c U . 4c ce— t G4 gy3 3(-_ Phoni6d05b y3?--og0�( Applicant Signature Date of Application z 5— Amount Paid Date of Payment Payment Type Ch Receipt# Received By Facility ID Pr8grard Record ID P/E Assigned to PWS ID FA00L5 R0503285 765 Rena LeRoy Report#:7067.rpt -o8-Pty