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o..aGir, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .`� 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:—sigov.org)ehd <br /> =" P� PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION:L'5 :51 <br /> //77 /J S� �.,.- CM: S� '1,4-.ti <br /> OWNER NAME: DATE: b JiA—I'I <br /> APN: APPLICATIONS: DEPTH TO FIRST WATER: <br /> SOIL TYPE' <br /> REMARKS:�G� �� //� -�� Ad, <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> - -- _- <br /> n i-Mr I - <br /> I I 5 <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil T e Depth Soil T e I Depth I Soil T e De th Soil T e De th Soil T e <br /> _ Test Hole#1 Test Hole#2 <br /> Parcel Diameter. inDB the in Parcel: Diameter: in De the n <br /> I <br /> TIME READING I WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> ec �I �� <br /> o v L —h_ - -- <br /> O <br /> c�D <br /> L c <br /> I <br /> PERCOLATION RATE:�'�/?i' min/in PERCOLATION RATE: minlin <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> ' 1 >�t.�,d,. <br /> TEST PERFORMED BY: - n rtn Phone: Date <br /> TEST CERTIFIED BY: Phone: Date OI n1 t <br /> _ OBSERVEDBY(RENS): (`L� Phone -yID� 4i5� Date , 3 V <br /> PERC TEST RATE FORM <br /> j EHD 42-03 REV 11/2109 <br /> I <br />