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DEEP <br />- ` <br />LTH 05-6232 <br />MENTAL HEA /ehd <br />Stockton, CA 952 <br />ENVIRON We <br />Www.sj9cv-or9 <br />1868 East Hazelton Avenue <br />�~ 20 Faz: (209) 464-0138 <br />. � Telephone: (209) 468-34COLA TEST RATE o c� t 5 - <br />PER TION <br />CITY: Ft <br />- DATE: <br />5 f l tt DEPTH TO FIRST WATER: <br />ADDRESS OR LOCATION: A LI t4 A <br />C A �vt IL <br />A OWNER NAME: .��' APPLICATION #: <br />+� <br />APN: —.0 O/z 2 iZ <br />S u/LLTG{L <br />Test Hol # 1 Test Hole # 2 <br />Parcel: t�) I Diameter: in , Depth: -2 Z9 jin Parcel: 0 Diameter: in I Depth: in <br />L <br />TIME I READING WATER DROP REFILLED <br />5' / <br />oho �s 34 <br />0: 0G I a5 fin' <br />PERCOLATION 'RATE: <br />RECOMMENDED SEPTIC <br />TEST PERFORMED By.- <br />TEST <br />Y:TEST CERTIFIED BY; <br />OBSERVED BY (RENS): <br />GO 42-03 REV 1112/09 <br />TIME <br />P <br />READING <br />WATER DROP i REFILLED <br />E <br />— <br />R' -OLA" N RATE: <br />RECOMMENDED.SEPTIC AREA: <br />Phone: <br />Phone: S� Date <br />Phone Date <br />Date C y 71 <br />