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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SERVICE REQUEST <br />Type of Business or Property <br />Battery Enemy Storage System <br />FACILITY ID # SERVICE REQUEST # <br />5(2. pagq [ P5 <br />OWNER / OPERATOR <br />CHECK if BILLING ADDRESS <br />FACILITY NAME <br />Cascade Energy Storage, LLC. <br />SITE ADDRESS <br />2482 Street Number <br />East <br />Direction <br />Carpenter Road <br />Street Name <br />Stockton <br />City <br />95205 <br />Zip Code <br />HOME or MAILING ADDRESS (If Different from Site Address) <br />Three Allen Center. 333 Street Number <br />Clay SL, Suite 2800 <br />Street Name <br />CITY STATE ZIP <br />Houston TX 77002 <br />PHONE #1 Err. <br />( 832 ) 671-0564 <br />APN # <br />179-140-18 <br />LAND USE APPLICATION # <br />PA-1900132 <br />PHONE #2 Err. <br />( ) <br />BOS DISTRICT <br />i <br />LOCATION CODE <br />gel <br />CONTRACTOR / SERVICE REQUESTOR <br />REQUESTOR <br />Brian Yarbrough <br />CHECK if BILLING ADDRESS -011•• <br />BUSINESS NAME <br />Cascade Energy Storage, LLC. <br />PHONE # <br />( 832 ) 671-0564 <br />Err. <br />HOME or MAILING ADDRESS FAx# <br />( ) <br />CM( STATE TX ZIP 77002 <br />BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br />acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project <br />or activity will be billed to me or my business as identified on this 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 S <br />COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws. N T / <br />APPLICANT'S SIGNATURE:,e54,.;:70., 9a4é44tgA DATE: 8/26/2021 OG 3 <br />PROPERTY / BUSINESS OWNER M OPERAT R / MANAGER b OTHER AUTHORIZED AGENT 0 202/ <br />ZIPROV/ cou <br />TYPE OF SERVICE REQUESTED: Review of Soils Report - So 1 5,..e fc-ib:b it 034 <br />Per the Conditions of Approval (RE: PA-1900132 (SA), SU0013545, submitte on Aug 12, 2020 <br />a soil suitability and nitrate loading study is required for County review pdor to review of the proposed design for a new septic system at this <br />location. BSK completed the associated soil suitability study (ref. BSK Project E21-002-01B) and it is being provided to the County for review <br />and comment, as applicable. <br />lacv-lin,S f.1-1/61y 11(4 Leer f re, v i .0%.-dy i k <br />ACCEPTED BY: BY:c..----72_.' 2_,L, EMPLOYEE #: DATE: 0 2 ) <br />ASSIGNED TO: A,,:, EMPLOYEE #: DATE: A OA 1 <br />Date Service Completed (if already completed): SERVICE CODE: 23 PIE: #a‘,007 <br />Fee Amount: * . c 0 8. Amount Paid 66E. DO Payment Date <br />Payment Type )/ / —it-- Invoice # Check # / 30 7/7K3 Received By: <br />If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required <br />AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property ti.4or4Itiqtreri:7-Y C. <br />above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assess Nr <br />information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is <br />provided to me or my representative. <br />EHD 48-02-025 <br /> SR FORM (Golden Rod) <br />REVISED 11/17/2003