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Please provide all information requested; an incomplete application may delay approval <br />❑ FACILITY INFORM&T AN <br />Name of Facility: TRACY HILLS GENERAL STORE <br />Street Address: 2250 CRISELDO MINA AVE. <br />City: TRACY Zip Code: <br />❑ FORMER NAME OF FACILITY <br />❑ BUSINESS OWNER INFORMATION <br />Business Owner Name: INTEGRAL COMMUNITIES <br />Home Address: <br />Mailing Address: 686 SAN CLEMENTE DRIVE SUITE 100, NEW PORT BEACH, CA 92660 <br />Telephone Number: <br />❑ PROPERTY OWNER INFORMATION <br />Property Owner Name: <br />Home Address: <br />Mailing Address: <br />Telephone Number: <br />CONTRACTOR INFORMATION _ <br />Name of General Contractor: <br />Mailing Address: <br />Telephone Number: <br />Contact Person on Site: <br />Site Phone Number: <br />❑ UTILITIES <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 />❑ FOOD INFORMATION <br />List food(s) to be served and/or provide menu: <br />OPERATIONAL INFORMATION_ <br />Anticipated Business Hours: Open: Close: <br />Anticipated Number of Employees: <br />EHD 16-01 4 PLAN CHECK GUIDE <br />7/5117 <br />