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Address: 261 S. Reid Avenue, Linden ID: SR0083995 <br /> _ �` •� ,._:err <br /> ENVIRONMENTAL HEALTH DEPARTMENT y <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> cx <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> .0.-d' <br /> • PERCOLATION TEST RATE <br /> • ADDRESSOR LOCATION: CIN: 3n <br /> L OWNER NAME: DATE: /� <br /> • APN. APPLICATION : DEPTH TO FIRST WATER: /5o Ft cif <br /> SOIL TYPE 57, <br /> REMARKS: I ' <br /> ,14 -44JU4 <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES <br /> LLI <br /> J Cr <br /> Cr <br /> LU <br /> LU 0 <br /> Of <br /> LL <br /> LI /V <br /> I — <br /> I <br /> SOIL PROFILE(IF REQUIRED <br /> De th Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> ,1 k• ' 1 <br /> CL <br /> Test Hol g#1 Test Hole#2 <br /> �� Parcel' Diameter: n Depth: n Pa cel: Diameter: in I Depth, in <br /> ��� TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> Ws <br /> . <br /> Y <br /> L <br /> minlin <br /> PERCOLATION RATE: minlin PERCOLATION RATE: ? <br /> RECOMMENDED SEPTICIAIRRECO E DED SEPTIC AREA: <br /> IK�A [ Phone Datef�er - # <br /> TEST PERFORMED BY: DatePw <br /> TEST CERTIFIED BY: Phone: r �4. <br /> OBSERVED BY(REHS): Phone 4e� ��3 b/� Date <br /> PERC TEST RATE FORM <br /> EHD 42-03 REV 112/09 <br /> c <br /> Naseem Ahmed, Registered Environmental Health Specialist <br />