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Please provide all information requested; an incomplete application may delay approval <br /> Name of Facility: Safeway #2600 mom ism <br /> Street Address: 18ol West 11th Street <br /> City: Tracy Zip Code: 95376 <br /> IE �; <br /> Business Owner Name: Safeway Inc <br /> Home Address: <br /> Mailing Address: 1371 Oakland Blvd, Suite 200, Walnut Creek, CA 94596 i <br /> Telephone Number: <br /> �Pro�pertyORnerRame-. Corral ixoJ.low LLC <br /> Home Address: <br /> Mailing Address: 1371 Oakland Blvd, Suite 200, Walnut Creek, CA 94596 <br /> Telephone Number: <br /> RaFeof <br /> -pR;1M� M .General Contractor: TBD <br /> Mailing Address: <br /> Telephone Number: <br /> Contact Person on Site: <br /> Site Phone Number: <br /> MatMOWi <br /> Source of Facility Water Supply: <br /> Backflow Protection: <br /> System to be used for Liquid Waste Disposal (Sewage): <br /> Solid Waste Disposal to be provided: <br /> Grease Interceptor: <br /> IF <br /> 01O .N <br /> List food(s)to be served and/or provide menu: <br /> Anticipated Business Hours: Open: Close: <br /> Anticipated Number of Employees: <br /> EHD 16-01 4 PLAN CHECK GUIDE <br /> 811114 <br />