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ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www s)gov orglehd <br /> PERCOLATION/TEST RATE <br /> DDRESS OR LOCATION: .p00 /' ? llll 7q -CITY: C4 t�"l i J�Op <br /> WNER NAME: (Xi I r r Ar 5 DATE. <br /> PN: - l- APPLICATION is S R DD Lr /- DEPTH TO FIRST WATER: <br /> OIL TYPE d " ( lyr�u�f' rta/r �Ct tc�P T iP �y rl �ooit� �aZJs -�Irrl if i <br /> EMARKS: ——---- ---— <br /> LOCATION OF TEST HOLES ISHOW WELLS AND STRUCTURES) <br /> �.._i <br /> — <br /> FILR I -fl T�T' <br /> t � FL777 <br /> SOIL PROFILE IF REQUIRED <br /> Depth I Soil Type Depth Soil T Depth Soil Type De th Soil T Depth Soil Type <br /> F�Zl. <br /> Test Hole#1 Test Hole# 2 <br /> Diameter ZI inDepth: in Parcel Diameter In Depth <br /> _ TtA1E READING WATER DROP REflLLED -, IintF l R2 APIN(, WATER DROP REFILLE11 <br /> !b: o D 3,6? <br /> ' - -- - <br /> L�00 7 -- <br /> PERCOLATION RATE: miNin PERCOLATION RATE: —min/in <br /> RECOMMENDED SEPTIC RF : RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: iZz?2-� Phone: L1F9)q—)A—ll yDate <br /> TEST CERTIFIED BY: Phone: <br /> Date T— <br /> ip13SERVEO BY(RENS): tiw� Phone Date <br /> D 42-W REV I11bW PERC TEST RATE FORM <br /> Il <br />