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SAN JOS:-JUIN COUNTY PUBLIC HEAL_ i SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION LAND LASE LOG <br /> LAND USE # I\ l i ADDRESS Z 3�6U 6o ( <br /> SURFACE - SUBSURFACE CONTAMINATION REPORT: SR# <br /> DATE RECEIVED DATE STAFF ACCEPTED REPORT: <br /> PROGRAM ELEMENT APN: <br /> CONDITIONS OF APPR VAL: YES V NO DATE SATISFIED PERMIT/SR# INITIAL <br /> GENERAL HEADING: DATE: <br /> A. ° 0 <br /> B. <br /> C. <br /> D. <br /> E. <br /> F. <br /> G. <br /> H. <br /> I. <br /> J. <br /> REVISED CONDITIONS (DATE/COMMENTS): <br /> SOIL SUITABILITY/NITRATE LOADING LETTER: DATE [NIT <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 />