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0 <br /> D <br /> 0 <br /> N Q <br /> N I"t W n) <br /> got+ M O <br /> M <br /> ENVIRONMENTAL HEALTH DEPARTMENT O <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 ILI <br /> G Telephone:(209)468-3420 Fax:(209)464-013B Web:www.sigov.orglehd C < <br /> o ra <br /> � PERCOLATION TEST RATE 0 <br /> 3 <br /> (D ADDRESS OR LOCATION: 17)4!5L !Ilri.� �r�< (1 !'r� CITY: �' N 0 <br /> r+ OWNER NAME: 54^A Sr t�Tc` DATE: `T�'t-2 (`-� ,may. <br /> rD <br /> Jn/'. M <br /> APN: U4•o Oc�n APPLICATION K: DEPTH TO FIRST WATER:,� Ft <br /> SOIL TYPE: - _ rr•F CL <br /> !y CL <br /> REMARKS: <br /> rt <br /> N <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) `G <br /> �• i ! 1 ' + � i t1i til-'�-���C 1-1—' <br /> �-- --II�,I1- <br /> I'D <br /> -- L!- Ll—� LL!_L! <br /> n) <br /> ; i l i i I fit, i <br /> l _ <br /> 0rj III I _ I I i 1—f I TTS I I <br /> SOIL PROFILE(IF REQUIRED) <br /> De th Soil T e De th Soil T e De th Soil T T e e De th Soil De!h Soil e <br /> Test Hole#2 { <br /> 9- Test Hole#1 Diameter. <br /> Diamen De the n <br /> Parcel: ter. in De the <br /> in Parcel: <br /> TIME READING <br /> WATER DROP REFILLED <br /> TIME READING WATER DROP REFILLED <br /> o I• I r 2 <br /> oC'o <br /> ;' <br /> 2 , z <br /> lj ,2+ Z minlin <br /> minlin PERCOLATION RATE: <br /> PERCOLATION RATE: RECOMMENDED SEPTIC AREA: <br /> 4 <br /> RECOMMENDED SEPTIC EA Date <br /> Phone' .11�110Date <br /> TEST PERFORMED BY: Phone: � <br /> TEST CERTIFIED BY: _ Phone Date <br /> PERC TEST RATE FORM <br /> OBSERVED BY(RENS): o <br /> EHD 42-03 REV 11 fM Q <br /> Ln <br /> X <br /> O <br /> aq 00 <br /> (D .. <br /> I + O <br /> Ln <br /> 0 O <br />