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Please provide all informa4k requested; an incomplete appostion may delay approval <br /> Name of Facility: Qdoba Mexican Grill <br /> Street Address: 1920 W. lith Street, Suite 1 <br /> City: Tracy Zip Code: 95376 <br /> Business Owner Name: Dennis Gras ointner <br /> Home Address: 2280 Nordic Way, Turlock, CA 95382 <br /> Mailing Address: 2250 Rockefeller Drive, Suite 7, Ceres, CA 95307 <br /> Telephone Number: (209) 538-9500 <br /> Property Owner Name: Stephen Bowie - Pacific Development Group <br /> Home Address: <br /> Mailing Address: Po Box 3060, Newport Beach, CA 92658 <br /> Telephone Number: (949) 760-8591 <br /> ❑ CONTqllRM <br /> Name of General Contractor: Doug Jackson <br /> Mailing Address: Po Box 578733 <br /> Telephone Number: (209) 848-2040 <br /> Contact Person on Site: Doug Jackson <br /> Site Phone Number: <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: Zurn 21165 (See attached) <br /> List food(s)to be served and/or provide menu: Menu provided(See attached) <br /> Anticipated Business Hours: Open: 10:30am Close: 1o:0opm <br /> Anticipated Number of Employees: 25 <br /> EHD 18-01 4 PLAN CHECK GUIDE <br /> 07-29-2010 <br />