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SAN JO _,iUIN COUNTY PUBLIC HEA,,,, H SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION LAND USE TRACKING LOG <br /> LAND USE # 110 S - (&-i a ADDRESS Q SSo 1 5. M--4-rq &j-il� {r o rtc"Au� <br /> SURFACE - SUBSURFACE CONTAMINATION REPORT: SR# <br /> DATE RECEIVED DATE STAFF ACCEPTED REPORT: <br /> PROGRAM ELEMENT )lo 3-3 APN: a'J0,? -LWO-clO <br /> CONDITIONS OF APPROVAL: YES �/NO_ DATE SATISFIED PERMIT/SR# INITIAL <br /> GENERAL HEADING: ,-) DATE: <br /> A. 10 ;0a <br /> B. 20 ; yl <br /> C. 15, o/ <br /> D. <br /> E. <br /> F. <br /> G. <br /> H. <br /> I. <br /> J. <br /> REVISED CONDITIONS (DATE/COMMENTS): 411051oo -k", <br /> SOIL SUITABILITY/NITRATE LOADING LETTER: DATE INIT <br /> WATER RESULTS WARNING LETTER: DATE INIT <br /> OCCUPANCY SIGN OFF: DATE INIT <br /> SURVEYOR LETTER: DATE INIT <br /> SAMPLING RESULTS: <br /> NITRATE DBCP <br /> EDB ARSENIC <br /> OTHER OTHER <br /> OTHER OTHER <br /> PERCULATION TEST RESULTS: <br /> HOLE # HOLE DEPTH PERC RATE (MIN/IN) PASS/FAIL <br />