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Please provide all information requested; an incomplete application may delay approval <br />FACILITY INFORMATION • <br />Name of Facility: MOUNTAIN HOUSE CHEVRON <br />Street Address: NEC OF INTERNATIONAL PARKWAY & DAYLIGHT ROAD <br />City: Tracy Zip Code: 95377 <br />FORMER NAME OF FACILITY • <br />N/A <br />BUSINESS OWNER INFORMATION • <br />Business Owner Name: MR. JIM RUBNITZ <br />Home Address: <br />Mailing Address: 17610 BLANCHARD DRIVE, MONTE SERENO, CA 95030 <br />Telephone Number: (408) 813-6416 <br />PROPERTY OWNER INFORMATION • <br />Property Owner Name: R & B DELTA II, LLC <br />Home Address: <br />Mailing Address: 1200 CONCORD AVE., SUITE 200, CONCORD, CA 94563 <br />Telephone Number: (925) 674-8400 <br />CONTRACTOR INFORMATION • <br />Name of General Contractor: T.B.D. <br />Mailing Address: <br />Telephone Number: <br />Contact Person on Site: <br />Site Phone Number: <br />UTILITIES • <br />Source of Facility Water Supply: CITY OF TRACY <br />Backflow Protection: 1 1/2" (SEE CIVIL DRAWINGS) <br />System to be used for Liquid Waste Disposal (Sewage): CITY OF TRACY <br />Solid Waste Disposal to be provided: TRACY DELTA SOLID WASTE MANAGEMENT <br />Grease Interceptor: N/A <br />FOOD INFORMATION • <br />List food(s) to be served and/or provide menu: <br />MENU ATTACHED <br />OPERATIONAL INFORMATION • <br />Anticipated Business Hours: Open: 24 HRS. Close: <br />Anticipated Number of Employees: 1-2 EMPLOYEES PER SHIFT! 3 SHIFTS PER DAY <br />EHD 16-01 <br /> 4 <br />PLAN CHECK GUIDE <br />7/5/17