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PA <br /> San Joaquin County-Environmental Health Department <br /> 1868 E.Hazelton Avenue-Stockton CA 95205-Phone: 209-468-3420 /i^n� D <br /> e.. f- <br /> /' <br /> APPLICATION �'J�.�H �O U/&C� <br /> ENVIRONMENTAL HEALTH tt y <br /> PERMIT TO OPERATE T�0�z 7A�� <br /> EMPLOYEE HOUSING OR LABOR CAMP Mevr <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 Permit ID#• <br /> *Additional Employees <br /> State ID#: <br /> EH ID#: <br /> Please Note any Corrections or Changes in Facility/Operator Information directly on this form. <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 Owner Phone#:(760)996-2252 <br /> Communitl Facilities Provided by Camp: Community Kitchen? ❑ Yes No <br /> Men: Number of Toilets 55 Number of Showers 55 Number of Lavatories 55 <br /> Women: Number of Toilets Number of Showers Number of Lavatories <br /> Housing Accommodations to be Utilized this Year: Occupancy Dates: <br /> Buildings Employees <br /> Dormitories 1 220 from 05101/2026 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 more Employees: <br /> MH/RV Spaces Note <br /> TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year <br /> 220 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 $50.00+ Number of Employees @$17.00 each=S <br /> ❑ Transfer of Ownership $25.00-S <br /> X❑ Permanent Amendment Fee $25.00+ Number of Additional Employees 220 @$17.00 each=S $3,765.00 <br /> ❑ Late Application Fee S100.00+ Number of Employees @$34.00 each=S <br /> Fee must be submitted with Application <br /> TOTAL FEE DUE$ $3,765.00 <br /> Remit TOTAL 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 1, Part 1, Division 13 of the California Health <br /> and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code of Regulations. <br /> Applicant Name SALOME RAMIREZ Title HOUSING COORDINATOR ❑Partnership <br /> (Please PRINT or TYPE) ®Corporation <br /> Address 101 E MAIN ST,HEBER,CA 92249 Phone 760-791-5114 <br /> Applicant Signature Date of Application 04/13/2026 <br /> Amount Paid Date)f Payment Payment Type Check/Receipt# Received By Account ID <br /> 37&5. 1- a� aI�s <br /> Facility ID Progrim Record ID PIE Assigned to PWS ID <br /> FA0024661 <br /> Report#:7066 Application Printed:3/29/2023 <br />