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SAN JCSJIN COUNTY PUBLIC HEAL&SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION LAND TRACKING LOG <br /> LAND USE # tt P - Gl5 - l �-->, ADDRESS <br /> SURFACE - SUBSURFACE CONTAMINATION REPORT: SR# <br /> DATE RECEIVED DATE STAFF ACCEPTED REPORT: <br /> PROGRAM ELEMENT 2C-JS / APN: S5 - / X30 - 0 Cl <br /> ✓ <br /> CONDITIONS OF APPROVAL: YES NO_ DATE SATISFIED PERMIT/SR# INITIAL <br /> GENERAL HEADING: l)y DATE: 10 3 <br /> A. /. 03 <br /> B. //.' 04 <br /> C. ' oy <br /> D. a 0 3 <br /> E. K-ttkp r ' <br /> F. <br /> G. <br /> H. <br /> I. <br /> J. <br /> REVISED CONDITIONS (DATE/COMMENTS): <br /> SOIL SUITABILITY/NITRATE LOADING LETTER: DATE INIT <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 />