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OAG UJN COUNTY • PUBLIC iC Ri AI. Z P,1'ICES <br /> kiVVIRONIMENTAL HEAL'T'H Dl�"KioN PbAYMENT � <br /> 304 E WEBER AVEWE* THIRD FLOOR• STOCKTON, CA 95202 -Q,E E. VE <br /> 2091468-3420 <br /> APPLICATION - <br /> JAN 1219 <br /> p f h V 041 f 6f 5 ENVIRONMENTAL HEALTIi <br /> i RERNUT TO fila 7� �uea x;HEA-TH SERVICES <br /> EMPLOYEE HOVSING OR LABOR CAMP 90ARONME"TAL HEA.L-�DIVISION <br /> 0 Nem campCol�dltloas�l Permts <br /> I= <br /> ❑Amended Perndt. Annual Permic k'or Calendar Year" 94 <br /> c=hange of operwor ❑ll�alttpla Ye8M(PertuauetA Houting CUMpg ca*) l <br /> _ aw roved <br /> hem of Owner �"' ®te M�llod: <br /> f -Chauge of Operator Add Dae w Chonge of Owner Addrers ermli ek ilF Z9SI <br /> { -Addldonrl E+thployeeh �a� # 314-08 <br /> Pletare Piotn wry CarrtCHaW aor rx CJkaaegesia E Opesrsterr✓!Pn np i� parr direety on th#s[orcca <br /> —_- .----- <br /> Site Name: Sr1RALir FARMS INC39-SS Location: I fni S l CLIFTON&z CALPACC'KK R CT <br /> --------------- - <br /> O entor: c 'STOCKTON <br /> _— TLALE FARMS INCN. <br /> *�2MaUfng Address:, . <br /> a �- ----- �P6_00X 6tfi6, $!pGKiON t;A"95206 . ". tt1: 2U9- '3-279 i <br /> Legal Owner: SAP-ALE Fr1RMrS INC <br /> -- -- —Fina EDttner 0 Y'es <br /> Owner Address: 16540 W CLIFTON CT,STOCKTON CA 95206 <br /> Owner Phone#:. 209-943-2079 <br /> Cotnmt nit aciii[les Provided <br /> by Cgm : Col mueity kitchen: yet rim, <br /> t FAUCETS) <br /> Wot3tetl:Number <br /> MFn: Number of Toilets i�iEamber ofShawora�i Number of lAvmtoriec 1q--qf <br /> mber of Teiilris Number ofShowers Xe .Number ofLavaterles (A <br /> llou5lag AMMIMWadons to be Utlfted this Year: --�� <br /> IOwnednr tl <br /> f Dermitarlas. �t�C H Owner Owned R4XfRY of { <br /> SF D-o&Iingrf � Owner Owned.RR Cars <br /> Aparupieats ( /x Y+l"vSpaces <br /> 'kOTAL Pf-Both COIaWdNS �J <br /> Oocn ert Da s: <br /> R A G I.1 S Total Number or Day-r to be med fids Gras+ dgx yewr <br /> koro {�! to�/ / P TWAT Axys Occup i d by l5 or w�as�Emylayee� <br /> — �: �uups accic�eq by 11 cer erav+t RS�ss for SD or Beare d a arm <br /> i re�usre a Pu51Je Hatrr,Syst�e PerAiait <br /> Q his p1die. i+uesarknf In order fa protect your land um stogy ifearnp;vi1l not bs a> A&year b:d faweaded fbrua�e far j*e C*eclt this Pax and rePunz <br /> this e�piat{e�uw <br /> e r,Schedule <br /> .k" - f a•i. Pesrr tanentgCamp Al111iull Perpnft$35.09+Number of Employees •40 Co $12.09 each <br /> r G Orchard Camp1Pernift Fee='$95.00 _ <br /> 0 Transfer ofOwnership=$20.00 $ <br /> Permit Allen"dmenl $2000+Nwnbor of A�:}itfonW Enhirjayees 12.4D eaeit — <br /> . , { $ _$ <br /> Date Application P'ee$70.00,+Number efEmploy-eos t f&}$24.06 each=$ <br /> Fee must be subInfttkd with Appleation `TOTAi,ftZ bUE: <br /> R (�� <br /> Ymr ToM I+ if As CALCLLATM ABOVE IN ENCLOSED self€+ddresset�EhTVSY,c►PE. �r�altl'CFfPCI }�9YIttC<3 2so: I,�f'no <br /> HD <br /> Applicant agrees m all accessary inspections Incident to kntmace ofB PrsRt�trr Taj Op$ qPg <br /> 11"e wApplicant agrees tient this prOkct(CAMP)shall be <br /> OpB1Y1tL:d athd hnaintalned in ts+:COrdith the.appliCable provhlons of the EMMOYEE HOMING ACT,Cba Ater 1,Pott i,Division 1.3 Oftlse Hc�tlth <br /> Ond WOW Corte olid Chapter 1.Subchapter 3,.Tale 25,C <br /> amwni'ta Corte Of RgWketiom. <br /> Applicant dNahne(Plmeprwor 'e) THOMAS SARALF Tide SECRETARY—TRFASURFR <br /> 9 Phavta}?f1Q_Ql1 �7f17q ' <br /> Applicant Slgriatnhe -- Date of Applicatlou { <br /> F�saArnow9t Amount Paid ant <br /> IkIPAK*i k* <br /> Ett=gtayea alt: 575$ Asst ia:Ot102523 Fos 98 i <br /> l0: 002PR dA 27aQ85 PYYS lIIil <br /> — P& 2755 1 <br /> .:� 4__ _ <br />