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SAN JOAQUIN Environmental Health Department <br /> C OU i\ITY - - <br /> CERTIFICATE OF NON-OPERATION <br /> CALENDAR YEAR 2026 <br /> Any person ceasing to operate or maintain employee housing is required to annually file a Certificate of <br /> Non-Operation with the enforcement agency for two 2 ears following the discontinuation. <br /> EMPLOYEE HOUSING FACILITY NAME: <br /> Budget Inn&Suites <br /> ADDRESS: PHONE: <br /> 3473 W Hammer Ln, Stockton, CA-95219 <br /> OPERATOR NAME: <br /> Venugopal Chigurupati <br /> ADDRESS: PHONE: <br /> 3473 W Hammer Ln, Stockton, CA-95219 (484)347-8434 <br /> PROPERTY OWNER NAME: <br /> Shreesamba Sadashiva Investments LLC <br /> ADDRESS: PHONE: <br /> 3473 W Hammer Ln, Stockton, CA-95219 <br /> REASON FOR NON-OPERATION(CHECK AS APPROPRIATE): <br /> ❑ Property Sold -To: Date Sold: <br /> ❑ Housing Destroyed—Date: <br /> 21 Housing Still Exists: <br /> Will not be occupied by any employees any part of this calendar year. <br /> ❑ Will only be occupied by less than 5 employees this calendar year. Maximum number of Employees who <br /> have or will occupy the housing during this calendar year.- <br /> El <br /> ear:❑ Other: <br /> AUTHORITY: <br /> California Health and Safety Code,Section 17037.5(a)-Any person who ceases to operate or maintain employee housing which is subject <br /> to the permit requirement pursuant to this part shall be required to annually complete and submit a Certificate of Non-Operation to the <br /> enforcement Agency. The Certificate of Non-Operation shall be submitted for two(2)years following the discontinuation of the use of any <br /> area on the property as employee housing.The Certificate of Non-Operation shall attest under penalty of perjury that the employee <br /> housing has been destroyed,or is no longer owned or operated,or has not been and shall not be occupied by five or more employees <br /> during the calendar year. <br /> California Health and Safety Code, Section 17037.5(b)-The Certificate on Non-Operation shall include the owner's name and address, <br /> the operators name and address,the employee housing name and location,the maximum number of employees who have occupied or <br /> shall occupy the employee housing during the calendar year,and any other information considered relevant by the enforcement agency. <br /> The Certificate of Non-Operation shall be completed and submitted to the enforcement agency no later than 30 calendar days after the <br /> enforcement agency rovides the form to the owner oroperator. <br /> CERTIFICATION: <br /> I, Venugopal Chigurupati as General Manager <br /> (Print Name) (Title) <br /> certify under penalty of perjury that the information provided herein is true and correct to the best of my knowledge. <br /> SIGNATURE (�,,. =i C j _ y; DATE 04/15/2026 <br /> crt <br /> EHD USE ONLY <br /> EMPLOYEE HOUSING _ PROGRAM PROGRAM <br /> ID: -_ RD[_-RECO, ID: PR ELEMENT: <br /> EHD 27-06 10/26/09 EMP HSG <br /> CE <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />