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Please provide all information requested; an incomplete application may delay approval <br /> ❑ FACILITY INFORMATION <br /> Name of Facility:Speedway t/4612 <br /> Street Address:2448 W. Kettleman LanE <br /> City: Lodi Zip Code:95242 <br /> ❑ FORMER NAME OF FACILITY <br /> ❑ BUSINESS OWNER INFORMATION <br /> Business Owner Name:Western Refining Retail, LLC <br /> Home Address:19100 Ridgewood Parkway, San Antonio,TX 78259 <br /> Mailing Address:19100 Ridgewood Parkway, San Antonio, TX 78259 <br /> Telephone Number:For this project: 661-250-9300 <br /> ❑ PROPERTY OWNER INFORMATION <br /> Property Owner Name:Tesoro Sierra Properties LLC <br /> Home Address:19100 Ridgewood Parkway, San Antonio, TX 78259 <br /> Mailing Address:19100 Ridgewood Parkway, San Antonio, TX 78259 <br /> Telephone Number:For this project:661-250-9300 <br /> ❑ CONTRACTOR INFORMATION <br /> Name of General Contractor:Perry Builders <br /> Mailing Address:12405 Lockley Lane, Auburn, CA 95602 <br /> Telephone Number:Forthis project: 661-250-9300 <br /> Contact Person on Site:For this project:A&S Engineering/Abigail Jara <br /> Site Phone Number:For this project:661-250-9300 <br /> ❑ UTILITIES <br /> Source of Facility Water Supply:Existing to remain <br /> Backflow Protection:Existing to remain <br /> System to be used for Liquid Waste Disposal (Sewage):Existing to remain <br /> Solid Waste Disposal to be provided:Existing to remain <br /> Grease Interceptor:Existing to remain <br /> ❑ FOOD INFORMATION <br /> List food(s) to be served and/or provide menu: <br /> Prepackage foods. <br /> ❑ OPERATIONAL INFORMATION <br /> Anticipated Business Hours: E.mtingtommaln Open: Close: <br /> Anticipated Number of Employees:Existing to remain <br /> EHD 16-01 4 PLAN CHECK GUIDE <br /> 7/5/17 <br />