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Site address: 4901 S. Biedermann Ave <br /> OA-c�Ir <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> '�•'— 1 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: �1P7/ gIGDFR iYlANN 111k✓ CITY: ``GQ Gds 953a..•a <br /> a OWNER NAME: -TESUZ t/G LAS(,-(AGE DATE: A 5i Q "Ozo <br /> APN: APPLICATION M DEPTH TO FIRST WATER: Ft <br /> SOILTYPE: �F�'Ry <br /> A <br /> REMARKS: -4ii -rA `401 A/A !'!1 hl L+0"&,0211((�, i7�k" mfr-rOAK ? 7Glf D TUG� <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> — - --- �; ' <br /> SOIL PROFILE(IF REQUIRED) <br /> De t Soil T e Depth Soil T e De th I null Tvuc I De th ISoil T e De th Soil T e <br /> Test Hole#1 '% Test Hole#2 <br /> Parcel Diameter. �.5 in 1 Depth: 4L? in I Parcei: I Diameter: - < in I Depth: in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> 112 -- <br /> n, _ i ?a /c <br /> �o G, 124 1 / a <br /> I .3 <br /> - p o1 / to ; <br /> PERCOLATION RATE: 9 min/In PERCOLATION RATE: �� 9 minlin <br /> RECOMMENDED SEPTIC EA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: Phone: Data <br /> TEST CERTIFIED BY: Phone:(go 9-4o2-/G!2 Date <br /> OBSERVED BY(REHS): Phone Date "Z�'zd2d <br /> PERC TEST RATE FORM 'r'x-E` a;-k. 4 Z <br /> EHD 42-03 REV 71/2)09 <br /> t- <br /> Naseem Ahmed, Registered Environmental Health Specialist <br />