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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SERVICE REQUEST <br />Type of Business or Property <br />Battery Energy Storage System <br />FACILITY ID # SERVICE REQUEST # <br />d3 44 7- el3/ <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 St., Suite 2800 <br />Street Name <br />CITY STATE ZIP <br />Houston TX 77002 <br />PHONE #1 Exr. <br />( 832 ) 671-0564 <br />APN # <br />179-140-18 <br />LAND USE APPLICATION # <br />PA-1900132 <br />PHONE #2 EXT. <br />( ) <br />BOS DISTRICT LOCATION CODE <br />CONTRACTOR / SERVICE REQUESTOR <br />REQUESTOR <br />Brian Yarbrough <br />CHECK if BILLING ADDRESS <br />BUSINESS NAME <br />Cascade Energy Storage, LLC. <br />PHONE # <br />( 832 ) 671-0564 <br />Ext. <br />HOME or MAILING ADDRESS Fax # <br />( ) <br />Crry „ 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 SAN JOAQUIN <br />COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws. <br />APPLICANT'S SIGNATURE: 34 ; 12.4.44.49 <br />PROPERTY / BUSINESS OWNER EI OPEFtAT R / MANAGER <br />t <br />OTHER AUTHORIZED AGENT 0 <br />If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required <br />Title <br />AUTHORIZATION TO RELEASE INFORMATION: When applicable, I, the owner or operator of the property located at the <br />above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/ <br />information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at <br />provided to me or my representative. <br />TYPE OF SERVICE REQUESTED: Review of Soil Nitrate Loading Analysis JON 1 . cc <br />5 1„ <br />COMMENTS: <br />: . j cu?, <br />Per the Conditions of Approval (RE: PA-1900132 (SA), SU0013545, submitted o# 2(ivA <br />a soil suitability and nitrate loading study is required for County review prior to review 12)41e.4,s,41,7 /.' <br />, <br />:4vr), <br />proposed design for a new septic system at this location. BSK Associates performed this stud§16* <br />drafted the associated report (ref. E21-002-01B) <br />ACCEPTED BY: Steven Shih EMPLOYEE #: DATE: 6/1/2021 <br />ASSIGNED TO: Aaron Gooderham EMPLOYEE #: DATE: 6/1/2021 <br />Date Service Completed (if already completed): SERVICE CODE: 523 P / E: 2602 <br />Fee Amount: $456 Amount Pa O /15Z , Payment Date As--c2,/ 7 <br />Payment Type V160._ Invoice # Check # /2„. 6 7 Lc- 4 3(,) Receive By: do_ <br />DATE: 6/10/2021 <br />essment <br />EHD 48-02-025 <br /> <br />SR FORM (Golden Rod) <br />REVISED 11/17/2003