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E New Facility □ Existing Facility <br />San Joaquin-County Environmental Health Department <br />Application Form <br />Facility Name River Islands K8 Elementary School <br />Site Address City State ZIPCALathrop 95330 <br />□ Consultation □ Change of Owner ® Repairs or Remodel S Other <br />License Plate Number VIN <br />□ Billing Party □ Facility Owner □ Facility Contact □ Property Owner □ Contractor □ Architect <br />SfBilling Party □ Facility Owner □ Facility Contact □ Property Owner □ Contractor E9 Architect <br />If contractor, indicate type and license numberFirst Name Last name WohleEric <br />Address City State ZIPStocktonCA 95204222 Central Court <br />Phone Email ewohle@ldapartners.com <br />□ Contractor □ ArchitectK Facility Contact □ Property Owner□ Facility Owner□ Billing Party <br />If contractor, indicate type and license number <br />Phone <br />□ Contractor □ Architect□ Facility Contact □ Property Owner□ Billing Party □ Facility Owner <br />If contractor, indicate type and license numberLast nameFirst Name <br />State ZIPCityAddress <br />EmailPhonePhone <br />10-09-2025DATE: <br />ARCHITECT <br />K OTHER AUTHORIZED AGENT □ OPERATOR / MANAGER□ PROPERTY / BUSINESS OWNER <br />Title <br />JAN 0 7,2026Linked FA IDAssigned ToAccepted By Vidal Pedraza Kadeanne Linhares <br />PE FeeDate1/6/26 5371601 <br />ITMENT <br />G^Confirmation #□ Check ti□ Cash 210050254 <br />Rev 07/10/2024 <br />Contact Types <br />required <br />If mobile food truck or <br />pumper truck <br />BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, acknowledge that all site and/or project <br />specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this <br />form. <br />I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes, <br />Standards, STATE and FEDERAL laws. <br />APPLICANT'S SIGNATURE: ■ <br />Last name <br />Pearlman <br />ZIP <br />95304 <br />APN <br />220-002-017 <br />First Name <br />Rechelle <br />Email <br />rpearlman@bantas(l.org <br />City <br />Tracy <br />Phone <br />209-943-0405 <br />State <br />CA <br />Type of Service <br />Requested <br />Comments <br />NEW ELEMENTARY SCHOOL CAFETERIA <br />Address <br />22375 El Rancho rd. <br />Phone <br />209-229-4651 <br />Coordinates 37°49'02.0"N 121°22,16.3"W, <br />(Parito Emata Way) <br />Supervisor District <br />Banta <br />□ Application for <br />Operating Permit <br />—t—r -----------------SANTAQUIN COUNTY <br />Payment <br />Received By ( <br />If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required PAYMENT <br />AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the above site address, hereby autba^e^he K <br />release of any and all results, geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL DECEIVED <br />DEPARTMENT as soon as It is available and at the same time it is provided to me or my representative.|