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Stockton Fire Department • Fire Prevention Division <br /> 345 N , EI Dorado Street, Stockton , CA 95202 <br /> Q D (209) 937-8271 • Fax (209) 937-8893 <br /> tr <br /> INSPECTION APPLICATION <br /> Application is hereby made for a inspection as required by the Stockton Municipal Code, <br /> . . . • . <br /> Application Date: 07/0612020 Location : City'or County ❑ <br /> Describe Type of Business/Services : Gas Dispensing Facility <br /> Business Name Pacific Car Wash Business Owner STHEM , LLC <br /> BusinessAddress 4415 Pacific Ave. Stockton, CA _ Suite _ _ Zip 95207 <br /> Mailing AddPess 300 Frank Ogawa Plaza Suite 340 Zip 94612 <br /> Business Telephone 209-478-5504 Contact Person <br /> ---- Rocs Hillesheim <br /> E-Mail Address rhillesheim@californaigroup.com <br /> Inspection • Eli <br /> - <br /> Check type of Inspection: <br /> 10fSpecial Inspection • City (charge per hour) <br /> ❑ Special Inspection - County Contract Areas (charge per hour) <br /> ❑ Permit and Code Compliance Inspection <br /> ❑ Permit and Code Compliance Inspection after 2nd Inspection (charge per hour) <br /> ❑ All other Field Inspections (charge per hour) <br /> Describe purpose of inspection : Temporary Closure, and piping & dispenser removal <br /> APPLICANT SIGNATURE—�AW ? auW DATE 7/6/2020 <br /> PRiNT NAME: Sarah Jablonsky-Construction Manager <br /> BELOW FOR OFFICE USE ONLY <br /> Issued by: Date Issued : 0 <br /> Check # -6 xf7�— F 17 <br /> ❑ Special Inspection • City: Pay Code XX $ 048-2631 -342 .23-00 <br /> ❑ Special Inspection - County Contract Areas : Pay Code XX $ 048-2631 -342. 23-10 <br /> ❑ Permit and Code Compliance Inspection: Pay Code XX $ ^_ 048-2631 -342. 23-00 <br /> ❑ Permit and Code Compliance Inspection after 2nd Inspection: Pay Code XX $ _ 048-2631 -342. 23-00 <br /> ❑ All other Field Inspections : Pay Code XX $ 048-2631 -342 .23- 10 <br /> INSPECTION DATE/TIME : <br /> INSPECTION RESULTS : <br /> INSPECTED BY: DATE <br /> 02112Ji6 FPD FORM Inspection Application White: FPD File Yellow: inspection Results to Customer Pink: Payment Copy to Customer <br />