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SAN JOAQUIN COUNTY <br /> iz.'' ENVIRONMENTAL HEALTH DEPARTMENT <br /> Naw600 East Main Street, Stockton, CA 95202-3029 <br /> y K <br /> • Telephone: (209)468-3420 Fax:(209)464-0138 Web:rwrw,sjgov.org/ehd <br /> PERCOLATION TEST RATE / /l <br /> ADDRESS OR LOCATION: <br /> C j t/N ti DATE: - <br /> OWNER NAME: <br /> APN: �� '� 0e DEPTH TO FIRST WATER: <br /> APPLICATION <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> PERCOLATION TEST SKETCHCREFILL�HEIGHT <br /> T SKETCH <br /> PE/ <br /> 2-IN DIA.PVC PIPE' RING <br /> 4-IN DIA.SOIL.BORING ��REFILL HEIGHTI 1 <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil Type Depth Soil Ty e Depth Soil T pe Depth Soil Type Depth Soil T pe <br /> Test Hol�1#11 Test Hole# 2 Depth: i 7 Parcel: Diameter: in Depth: <br /> TIME READING WATERDROF REFILLED TIM= RFF.n!NG WATER DROF REFILLEU <br /> 1 <br /> 6 <br /> G, 3-0 <br /> I%2 6 <br /> ►,3. minlin PERCOLATION RATE: —_--_ minlin <br /> PERCOLATION RATE: ------ <br /> RECOMMENDED SEPT REA:_—_ _}�� RECOMMENDED SEPTIC AREA: _--- <br /> TEST PERFORMED BY: %'` Phone: �bG�L_ Date <br /> _ _ ___ � Phone: _��1211��_ Date <br /> TEST CERTIFIED BY: — <br /> OBSERVED BY (RE �: ` -- = Phone-- �_`_� Date J� lS <br /> PERC TEST RATE FORM <br /> EHD 42-03 REV 1112109 <br />