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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT SERVICE REQUEST Type of Business or Property FACILITY ID # REQUEST # Brian Yarbrough BUSINESS NAME nSERVICE 0V'�53 BatteryEner Storage System Cascade Energy Storage, LLC. 832 671-0564 OWNER / OPERATOR FAX # ( ) CHECK If BILLING ADDRESS FACILITY NAME Cascade Energy Storage, LLC. SITE ADDRESS 2482 East Carpenter Road Stockton 95205 Street Number Direction Street Name city Zip Code HOME or MAILING ADDRESS (If Different from Site Address) Clay St., Suite 2800 Three Allen Center. 333 Street Number Street Name CITY STATE ZIP Houston TX 77002 PHONE #1 ExT. APN # LAND USE APPLICATION # ( 832 ) 671-0564 179-140-18 PA -1900132 PHONE #2 ExT. BOS DISTRICT LOCATION CODE ( ) CONTRACTOR / SERVICE REQUESTOR REQUESTOR CHECK If BILLING ADDRESS Brian Yarbrough BUSINESS NAME PHONE# ExT. Cascade Energy Storage, LLC. 832 671-0564 HOME or MAILING ADDRESS FAX # ( ) CITY �'- STATE l X ZIP 7002 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: �F4Z . li � � DATE: 8/26/2021 PROPERTY/ BUSINESS OWNERI0 OPERATOR / MANAGER ❑ OTHER AUTHORIZED AGENT ❑ If APPLICANT is not the BILLING PARTY_proof of authorization to sign is required Title 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 tl,�me time it is provided to me or my representative. M, TYPE OF SERVICE REQUESTED: Review of for Per the Conditions of Approval (RE: PA -1900132 (SA), S00013545, submitted on Aug 12, 2020 I �cr 1 y�FN�,0 QUI 6 �0?1 A`T N 4)�pAR CNT Y FNT ACCEPTED BY: I EMPLOYEE #: I DATE:/aa/a J ASSIGNED TO: A r EMPLOYEE #: DATE: 9/aa 51 Date Service Completed (if already Completed): SERVICE CODE: S,� 3 P / E: q ap Fee Amount: 3 1 J Amount Pai 3/. U Payment Date Payment Type I h SG Invoice # Check # 8742-94 Receiv d Bye, EHD 48-02-025 SR FORM (Golden Rod) REVISED 11/17/2003