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San Joaquin County-Environmental Health Department <br /> 1868 E Hazelton Ave-Stockton CA 95205-Phone: 209468-3420 <br /> APPLICATION <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP 1 <br /> ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ® Annual Permit for Calendar Year 2026 <br /> ❑ Amended Permit: *Change of Operator *Change of Owner <br /> *Change of Operator Address *Change of Owner Address <br /> *Additional Employees <br /> State ID#:39-15855-EH <br /> Please Note any Corrections or Changes in Facility/Operator Information directly on this form. <br /> Site Name: RIPON FARMS 39-430 Location: 23531 S JACK TONE RD RIPON <br /> Operator: RIPON FARMS 39-430 Email:tom@tomhoganlaw.com <br /> Mailing Address: 1532 SCENIC DR,MODESTO CA 95355 Facility Phone#: (209)492-9335 <br /> Legal Owner: HOGAN,THOMAS P New Owner? ❑ Yes ® No <br /> Owner Address: 1532 SCENIC DR,MODESTO CA 95355 Owner Phone#: (209)604-5280 Email:tOm @ tomh0 an 1 aw.C Om <br /> Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No <br /> Men: Number of Toilets Number of Showers Number of Lavatories <br /> Women: Number of Toilets Number of Showers Number of Lavatories <br /> Housine Accommodations to be Utilized this Year: Occupancy Dates: <br /> BuildinEs Employees <br /> Dormitories from O 1 /O 1/ 26 to 12/31/2 6 Crop Varies <br /> SF Dwellings from / / to / / Crop <br /> Apartments 8 8 <br /> Owner Owned MH/RV Total Number of Days to be used this Calendar Year: 36 <br /> Owner Owned RR Cars Total Days Occupied by 25 or more Employees: 0 <br /> MH/RV Spaces Note <br /> TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year <br /> ® ® Require a PUBLIC WATER SYSTEM Permit <br /> ❑Inactive <br /> 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. <br /> Fee Schedule <br /> Permanent Camp Annual Permit Fee $54.00+ Number of Employees 8 @$17.00 each=$1 9 0. 0 0 <br /> ❑ Transfer of Ownership $25.00=$ <br /> ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ <br /> ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ <br /> Fee must be submitted with Application TOTAL FEE DUE$1 9 0. 0 0 <br /> Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed Envelope <br /> MAKE CHECKS PAYABLE to EHD <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 and <br /> Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name Thomas P. Hogan Title Owner/Operator ❑Partnership <br /> (Please PRINT or TYPE) ❑Corporation <br /> Address 1207 13th St. , STE 1 Modesto CA 95354 Phone (209) 604-5280 <br /> Applicant Signature 1 Date of Application O 1/0 7/2 0 2 6 <br /> Amount Paid Date of Payment EPayment Type Check/Receipt# Received By <br /> 1 n 2v 2 - sv <br /> Facility10 Program Record ID PIE Assigned to PWS ID <br /> FA0020798 11R0536203 �765 Rena LeRoy <br /> pwaAENT d <br /> Report#:7067.rpt R E G <br /> f Qh 2 0 2026 <br /> a,IOAOUIN COUNTY <br /> ;I:ONPIENTAL <br /> .I!M I'ARVAN, <br />