LSJ Employees, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Isj.islandq_egmail.com Accounts payable department contact information Isj.apd(regmail.com Fax: 340-775-2528 Vacation / Leave Form Name: Thomas.) Melnick Date of Request 5/11/12 Dates of Requested: Date of First Day of Vacation: Total Number of Days: June 8th 2012 Date Return to Work July 2nd 2012 Leave Days: Weekend Days: Holidays: in Personal / Sick: Days Remaing: 16 8 0 days Type of Leave: 67 Vacation with Pay C' Leave without pay C' Personal Sick Leave C' Other If Other Explain: List of all contact information: Phone: Cell: Email: The following must be verified with Estate Manager 1. The number of vacation days you have taken. 2. The number employee in your division / department that are leave at the same time Approved: EFTA_R1_00555673 EFTA02039982