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otq�!n, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y: C <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �A�IFORN`P <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: �`—T (1,1l �. CITY: �� I <br /> OWNER NAME:_ l;Se*)]4 J'`' DATE: <br /> APN: Q I S — ��Q — y(,? APPLICATION#: S tog ] y v DEPTH TO FIRST WATER: <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES <br /> t f l <br /> r � d •: i ` I i i ' i 's � I <br /> I—f. <br /> 1v i i <br /> FP ' F1 l { . <br /> : <br /> i 1 E <br /> 1 1 I 1 1. i-' 1i�� <br /> i 1 5 <br /> SOIL PROFILE (IF REQUIRED <br /> Depth Soil Type Depth Soil T e Depth Soil Type De th Soil Type Depth Soil Type <br /> Test Hole# 1 _ Test_ Hole#2 <br /> Parcel: ; Diameter: N in j Depth: O in Parcel: Diameter: in Depth: in <br /> I <br /> /TIME READING WATER DROP REFILLED _ TIME READING WATER DROP REFILLED <br /> : 1 -- -- -- - ----- — <br /> Y i .S <br /> _ p ` f + —— — --- <br /> ��. 433 y <br /> { <br /> i H �' I l¢ 4•`'S5 � 0 -- <br /> PERCOLATION RATE: O l o min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: '``�'c'` Phone: '-y P1 '�U1 '�j \ Date <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(RENS): _/( Phone 2-e7jq(0r--&,tXV Date Z-2--Z--LA -z-d <br /> EHD 42-03 REV 1112/09 PERC TEST RATE FORM <br />