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......• ..,.,".,r caln ut"Ilt(IMENT <br /> �t a 600 East Main Street,Stockton.CA 95202-3029 <br /> Telephone.,(209)468-3420 Fax:(209)464-0138 Web:\vww.Sjgov.orglehd <br /> �xf oar\ 1P <br /> PERCOLATION TEST RATE <br /> .A l� ADDRESS OR LOCATION: I 1 0(R E- St. rz7. I zo CITY: IM+°(nITEcA <br /> OWNER NAME: jC V-I� MADZIC r2 -ATE: 'I_I�/! <br /> APN. Z 0.3(r• -Z F9 APPLICATION K: DEPTH TO FIRST WATER FT <br /> SOIL TYPE <br /> REMARKS. <br /> wow- <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES) <br /> PERCOLATION TEST SKETCH - PERCOLATION TEST SKETCH _ <br /> ?-IN DIA'PVC P1PG' - <br /> 2-[IQ DIA.PCC PIPE- -- <br /> J-fN DIA.SUn.DORING - 4-IN DI.\.SI,IL BGRING <br /> 3.a3 <br /> -- REFILL HEIGHT �s -- - ---- 1<11-ILL HFIGH' - <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> Test Hole#1 Test Hole#2 <br /> Parcel: Diameter: J4 in I Depth: 3.03 Parcel: I Diameter: in Depth: <br /> TltiE READING WATER DRop REFILLED TIME RFAD"IGX''. M I:- <br /> o R — 3.Ilk <br /> o .Db <br /> a:oa 4.5 .Sa I� <br /> a*30 q.(01 .4 <br /> /.'ob .5 ,+i 3 14,18 <br /> 4.0 q q.20 <br /> o oR t,g <br /> PERCOLATION RATE: �Q minlin PERCOLATION RATE: _minlin <br /> RECOMMENDED SEPTIC AREA: _ RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: loq l3GCa Phone:.10q,f? Fsa Date 5-17 I <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(RENS):Ned_ -� - _ Phone_?�y-Gam►-7(�.��_ Date S-n-I 9 <br /> It EHD 42-03 REV 112M9 PERC TEST RATE FORM <br /> Naseem Ahmed, Registered Environmental Health Specialist Page 1 of 1 <br />