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�4 SAN JOAQUIN COUNTY <br /> C <br /> i --•�� 'Q1, ENVIRONMENTAL HEALTH DEPARTMENT <br /> :� <br /> A <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehd <br /> q� FoR PERCOLATION TEST RATE <br /> j <br /> CITY: ��' , <br /> ADDRESS OR LOCATION. --7- <br /> p�i� �� vrC I—�tYrllS DATE_ /7 <br /> OWNER NAMES: ( j Ft <br /> DPN: APPLICATION#: P/T '/ 3 U���5 DEPTH TO FIRST WATER: <br /> SOIL TYPE. <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> -FPERCOLATION <br /> N T—EST SKETCH <br /> I -i---4 <br /> PERCOLATION <br /> i TEST <br /> EST SKETCH <br /> 2-IN DIA.PVC PIPE/ <br /> A-PVC PEPE/ 4-IN DLA.SOIL BORING <br /> SOIL BORING <br /> 32 <br /> RFS TFG <br /> REFILL l <br /> ffF <br /> - <br /> .. <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil Type Depth Soil T pe Depth Soil T e Depth Soil T e Depth Soil Tu— <br /> Depth <br /> Test Hole#1Test Hole#2 <br /> Diameter: in 1.Depth: 1,2 1 Parcel: Diameter: in Depth: <br /> TIME READING VVATERDROP REFIL/LEEDDf Tim- WATER DROF REFILL: <br /> -39 ,q . <br /> fa> 3y , 9 <br /> 3v 30 3 <br /> -7T <br /> L, <br /> 3 <br /> PERCOLATION RATE: _�_ � —____min/in PERCOLATION RATE: _--_—_—__—min/in <br /> RECOMMENDED SEPTIC REA:------ �� RECOMMENDED SEPTIC AREA: _ --- <br /> TEST PERFORMED BY: Phone: Date _ _ - --- <br /> TEST CERTIFIED BY: Phone: - 2(_2 jjr _ Date <br /> OBSERVED BY (RSH --- <br /> Phone_ � <br /> Z� Z_ �i Date �1 <br /> FERC TEST RATE FORM <br /> EHD 42-03 REV 11009 <br /> -32 Z `3� <br />