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E New Facility □ Existing Facility San Joaquin County Environmental Health Department Application Form Facility Name River Islands High School Cafeteria 16601 Loganberry WaySite Address City State ZIPLathropCA 95330 □ Consultation □ Change of Owner □ Repairs or Remodel I3 Other License Plate Number VIN □ Facility Contact □ Property Owner □ Contractor□ Billing Party □ Facility Owner □ Architect □ Facility Contact □ Property Owner □ Contractor 8 Architect□ Billing Party □ Facility Owner Wohle If contractor, indicate type and license numberLast name State ZIPStocktonCA 95204222 Central Court Phone □ ArchitectKI Facility Contact □ Property Owner □ Contractor□ Billing Party □ Facility Owner If contractor, indicate type and license number Phone □ Architect□ Property Owner □ Contractor□ Facility Contact□ Billing Party □ Facility Owner If contractor, indicate type and license numberLast nameFirst Name ZIPCityStateAddress EmailPhonePhone 02-24-2026DATE: ARCHITECT K OTHER AUTHORIZED AGENT □ OPERATOR / MANAGER□ PROPERTY / BUSINESS OWNER Title Linked FA IDAssigned ToAccepted By Kadeanne LinharesVidal Pedraza FeePEDate2/24/2026 5371601 □ Confirmation #216306514□ Check #□ Cash Rev 07/10/2024 Contact Types required Last name Pearlman BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this form. 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, Standards, STATE and FEDERAL laws. APPLICANT'S SIGNATURE: : First Name Rochelle If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative._______________________________________________ Email rpearlman@bantas( l.org APN 213-620-11 City Tracy ZIP 95304 Phone 209-943-0405 State CA Type of Service Requested Comments NEW High School Cafeteria If mobile food truck or pumper truck Address 22375 El Rancho rd. Phone 209-229-4651 Supervisor District Banta □ Application for Operating Permit First Name Eric *Alternate contact: Jesus Valdez Address Payment Received By | City Email ewohle@ldapartners.com *Alternate: ivaldez@ldapartners.com