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-4 f D D <br /> 00 <br /> a <br /> I <br /> � ap if � r-- <br /> ;r cNif <br /> W " d� ENVIRONMENTAL HEALTH DEPARTMENT I`' <br /> O <br /> ;:.� 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.orglehd O O N <br /> m k1i!'rytHT <br /> PERCOLATION TEST RATE N <br /> �• ADDRESS OR LOCATION: 2'122—2 N. S i'DLE}ZSTZ n1L DYZ7 47 <br /> O CITY: M An.,PG <br /> OWNER NAME: 12 00,11" UCLA PCNA -52 ?.0 2-0 •••i CL <br /> G'C j-l(rJ-(5, DATE: M <br /> APN: CA <br /> APPLICATION#:SICOJR 7- t{L DEPTH TO FIRST WATER: FI <br /> SOIL TYPE r.N— -4A c�,,,! LBAF� rr <br /> REMARKS: <br /> (D <br /> _ <br /> r <br /> p <br /> (D � <br /> a) LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURFs D <br /> Xi I <br /> V1 PCAcounon ncr vncx (. —1 I i ruwurloll nsr#xTul Sal <br /> ° <br /> 3,l5 <br /> (��1 'I J 61T VIwN __. __.. .. . J 0.1T P..•l <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Ty Depth Soil T De th Soil Type Depth Soil Type Depth Soil T e <br /> 0'-'3 1 V s CIA <br /> Test Hole#1 Test Hole#2 <br /> Parcel: I Diameter: 4 in I De th 3. Z in Parcel: Diameter: in 'Depth: in <br /> TIME READING WATER DROPREFILLED TIME READING WATER DROP REFILLED <br /> Uv Lf.4(,y <br /> 4.3 4.4b 11 .`I 44 <br /> CA OC `f,b335 4,SZ <br /> 9:so '1.83 .-31 Ll.5() <br /> rU:oo `i.Ql 4M.31 4•y3 <br /> 1O"30 Y. l Z8 4•N� <br /> Il:oo 4.� .3r 4.52 <br /> 11.70 4.`h0 .ZB 4•S <br /> RCOLATION RATE: $.9 3 minlin PERCOLATION RATE: <br /> minlin <br /> COMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: I <br /> FORME' �4� Phone: =D4 364 07?K Date S/ts/w <br /> ST CE Y: Phone: Date <br /> y,•� H Phone Date S <br /> PERC TEST RATE FORM <br /> A2-03 REV 17/7/08 <br /> (11 <br /> l7 <br /> 0 <br /> DJ <br /> Q <br /> CD Q <br /> V) <br /> O O <br /> 0 <br /> N 00 <br /> N <br /> •P <br /> 00 <br /> 0) <br />