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VIfy SAN JOAQUIN COUNTY <br /> x•'ay,CE'-p <br /> c �r� *. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> (� / P(PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: - 12_6 ; c 7G�1 M I eG,�/�- �. CIT,: L C I <br /> OWNER NAME:_ ��/11 LI I��- Vl DATE: <br /> APN: _0'-) I [ APPLICATION A:_SIQ �U� DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> 1 \ LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES <br /> _. <br /> /FT I <br /> X: <br /> _ <br /> 1 <br /> SOIL PROFILE IF REQUIRED <br /> De th Soil T pe Depth Soil T e Depth Soil Type De th Soil Type De th Soil Type <br /> _ Test Hole# 1 j _ Test Hole_ #2 <br /> Parcel: I Diameter: 4 in De theZ in Parcel: Diameter: in De the i <br /> TIME READING WATER DROP REFILLED _ TIME READING WATER DROP REFILLED <br /> _D `�-, l �a- -o 012-r t <br /> Z G <br /> i�, co ,q-7 <br /> a: 55 2 28 <br /> oU , <br /> 10 <br /> 2A-) <br /> �3 � -- - <br /> PERCOLATION RATE: 2- 3 min/in PERCOLATION RATE: <br /> RECOMMENDED SEPTIC A A: min/in <br /> RECOM ENDED SEPTIC AREA: <br /> TEST PERFORMED BY: Q,,n(,��'7A �;�� Phone: Date ` <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(RENS): L Phone- �' -C�33� Date 3 <br /> EHD 42-03 REV 1112/09 ---- <br /> PERC TEST RATE FORM <br /> 1 �-ti2 <br />