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PAYMENT San Joaquin County-Environmental Health Department RECEIVED 1868 E IIazelton Ave-Stockton CA 95205-Phone: 209-468-3420 APPLICATION Nov 2 1 2025 ENVIRONMENTAL HEALTH PERMIT TO OPERATE $AN JOAQUIN COUNTY' EMPLOYEE HOUSING OR LABOR CAMP [1`,f1•ENWIIRONNMMEQNTAL ❑New Camp []Conditional Permit E] MultipleYears(Permanent housing Camps only) ® Annual Permit 1'or C`' Y6'A'K7lftIIU"`� ENT ❑ Amended Permit: *Change of Operator *Change of Owner *Change of Operalm•Address *Change of Owner Address *Additional Employees State ID#: 3q -i 5'']l7 q- EH Please Note tiny Corrections or Changes in Facility/Operator Information directly on this form. Site Name: PANELLA PROPERTIES L'I'D 39-423 Location: 478017 FREMONT ST S"t OCICfON Operator: PANELLAI'ROPER7'IESI;I'D39-423 Moiling Address: PO 13OX 5010,STOCKTON CA 95205 Facility Phone#: (209)943-.000 Legal Owner: PANELLA PROPERTIES LTD New Owner? ❑ Yes 5d No Owner,Address: PO BOX.010,STOCICI'ON CA 95205 Owner Phone ii; (209)981-1531 Email: Community Facilities Provided by Cam ' S,ommunity Kitchen? ❑ Yes No Men: Number of Toilets 2 Number of Showers 3 Number oi'Lavatories 3 Women: Number of Toilets Number of Showers Number of Lavatories Housiue Accommodations to be Utilized this Year: Occupancy Dates: Buildings Employees Dormitories from 0/ / 2 4 to 11/ 39 2(* Crop SP Dwellings from — / / to / / Crop .Apartments _ p Owner Owned M FI/RV Total Number of Uays to be used this Calendar Year: I Q O Owner Ov`med RR Cars Total Days,000upied by 25 or more Employees: MF]/RV Spaces Note TOTALS � Camps occupied by 25 or more Employees foi•60 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 the future,Check this Box and return this application. Fee Schedule ❑ Permanent Camp Annual Permit Fee $54,00+ Number of Employees i Z @$17,00 each ❑ TransferofOwnetship $25.00=5_-- — ❑ Perniment Amendment Fee $25.00+ Number of Additional Employees a $17.00each=$_____—.. ❑ Late Application Pcc $108.00+ Number of Employees ©$34.00 each=$ ._ Fee must be submitted with Application TOTAL FEE DUE S Remit TOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed L'nvelope MAKE CHECKS PAYABLE to EI-ID 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 provisious of the EMPLOYEE HOUSING ACI',Chapter 1,Part 1, Division 13 of the California llealth and SnfeO;Code and Chapter 1,Subehapler 3,"1 itle 25,California Code of Regulations. g o o 19(t_k p Is,r4 E�A — Title ❑Partnership �1 Applicant Name _-- ��';_ (Please PRINT or TYPE) ..C�or�por�ation Address 5000 . Date of1A'hpnpnlcir2ti�onApplicantSignaturc Amount Paid Date of Pa en Payment Type Che Receipt# Received By ��• � � -- -- k- -- Facility ID Program Record ID PIE Assigned to PWS ID � FA0016215 PRO2421 1 7 Sastina Thammavongsa Report#:7067.rpt