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SAN JOAQUIN COUNTY <br /> 2 - ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> N ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> 4��FORN`P <br /> /� PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: �/(�/o� �{/, 7w,el 4eQ 64i <br /> CITY: <br /> OWNER NAME: "_.rO�/Q(E Q��T gw- S DATE: <br /> APN: APPLICATION#: DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> i <br /> i t ; <br /> :. i I <br /> [ 1_._ ..i i_ <br /> -• <br /> I I 4 I I <br /> ......... <br /> - <br /> I <br /> i : I <br /> : <br /> 11 � L__. <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil T Depth Soil Te Depth Soil Type De th Soil Type Depth Soil T e <br /> _- Test Hole# 1 I Test Hole#2 <br /> Parcel: Diameter: in Depth: in Parcel: Diameter: in Depth: in <br /> TIME READING WATER DROP REFILLED TIME <br /> it •�d— 2/ �� " READING WATER DROP REFILLED <br /> 9 00 3/ s <br /> D,C)9 — +— r Z 3 <br /> 355� <br /> PERCOLATION RATE: 27 min/in PERCOLATION RATE: <br /> RECOMMENDED SEPTIC AREA: /Z 00 S iT, min/in <br /> RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: /_.�/�4i Phone: Date <br /> TEST CERTIFIED BY: Phone: —�T <br /> Date <br /> OBSERVED BY(RENS . Phone- ��,�, - � Date Z�� <br /> EHD 42-03 REV 11/2/09 <br /> PERC TEST RATE FORM <br /> 12- G,L 3�F l/Z - `�z /vl <br /> /2-' -3c,- 'ys 'i - S/s:1- <br />