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San Joaquin Counh-Environmental Health Department le/ s� <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 1 n� v b <br /> APPLICATION ��{. 'fVj NC <br /> E:NVIRONMENTALHEALI'llwNh, <br /> PERMIT TO OPERATE <br /> EMPLOYEE HOUSING OR LABOR CAMP <br /> ❑New Camp ❑Conditional Permit ❑ Multiple Yeurs(Permanent(lousing Camps only) ®Annual Permit for Calendar Year 2026 <br /> ®Amended Permit *('hangs of Operator •Change or Owner <br /> 'Chunge of Operator Address -Change of Owner Address Permit ID#: <br /> •Additional E:mplovees <br /> State ID#: <br /> Pleacr .Nutt unr Can etviurrs or Changev in Facilih'%Operator Information direcrA d ro on this/tat. Ell ID#: <br /> Site Name: WATERLOO INN Location: 3951 BUDWEISER CT,STOCKTON <br /> Operator: FRESH HARVEST,INC. <br /> Mailing Address: 101 E MAIN ST.HEBER CA 92249 Facility Phone#:(760)791-5114 <br /> Legal Owner: KHUSAL,MEERAN New Owner? ❑Yes ® No <br /> Owner Address: 101 E MAIN ST,HEBER CA 92249 Owncr Phone#:(760)996-2252 <br /> Community Facilities Provided by Camp: Community Kitchen^ ❑ Yes ❑X No <br /> Men: \'umberuf Toilets S5 NumberofShowers 55 I;umber ofLavatories 55 <br /> Women: Number of"[oilets Number of Showers Numbcr orLavatories <br /> Ilousine Accommodations to be l'tilized this 1"car,. Occuoanes'Dates: <br /> Buildines Employees <br /> Dormitories I 220 from 05,01/2026 to 12/31/2026 Crop Garlic <br /> SF Dwellings from _/ to_/_/ Crop <br /> Apartments <br /> Owner Owned MH,RV Total Number of Days to be used this Calendar Year: <br /> Owner Owned RR Cars Total Days Occupied by 25 or morc Employees; <br /> M I I/RV Spaces \etc <br /> TOTALS Camps occupied by 25 or more F.mplosces for 60 or more days in a year <br /> 220 Require a PUBLIC N'ATER SYSTENI 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 liinue.Check this Roy and return this application. <br /> Fee Schedule <br /> ❑ Pernument Camp Annual Pernut Fee $50.00 Number of Employees Ca:.1117.00 each=S <br /> ❑ Transfer of Ownership S25.00 S <br /> Q Pennanent Amendment Fee S25.(N) Number of Additional Fmpioyecs 220 C$17.00 each -S $3,765.00 <br /> ❑ Late Application Fcc $100.0(1 t Number of Fmpinvccs C%S34.00 each-=S <br /> Fee must be submitted with Application <br /> ]'OTA1.FEE DIE;c S3,765.00 <br /> Remit TOLL FEE as CALCULATED ABOVE in the ENCLOSED Self-adressed 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 I, Part 1, Division 13 of the California Health <br /> and Safery Code and Chapter I,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name SALOME RAMIREZ Title HOUSING COORDINATOR ❑Panncnhip <br /> (Please PRINT or TYPE) ®Corporation <br /> Address 101 E MAIN ST,HEBER,CA 92249 Phone 760-791-51 14 <br /> Applicant Signature Date of Application 0 /1 3/2026 <br /> Amount Paid Data ref Payment Payment Type ChecklRecalpt 0 Received By Account ID <br /> I� ,-, - <br /> Facility ID Progrium Record ID WE Assigned to PWS ID <br /> FA0024661 PR0543451 2755 Sastina Thammavongsa <br /> Reoon#.7066 Application Printed:312912023 <br />