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oPa�lK. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: �� ° />_ �/ CITY: <br /> OWNER NAME: Petr DATE: 2-2- <br /> A P N: <br /> ZAPN: 5Z "' APPLICATION#: DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: Q <br /> I <br /> REMARKS: a6f, V _ Z 1z /( 1 <br /> LOCATIONOF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> _i917_ <br /> Ll <br /> ..-L ±HT <br /> � <br /> • - - - <br /> IT• - <br /> 71 1 1 17 <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil TyPq De th Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> jllMe. ` r Ig d6 <br /> /4 <br /> Test Hole# 1 Test Hole#2 <br /> Parcel: Diameter: in I Depth: in I Parcel: Diameter: in I Dept in <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> 0 <br /> 1 G E <br /> -71 1v <br /> -19(9 (2 3 ✓ <br /> e <br /> 69 P .Z77 <br /> PERCOLATION RATE: a 6?�� min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC REA: RECO E EDSEPTIC AREA: <br /> TEST PERFORMED BY: ,/�/� Phon (' ��< U0 Date <br /> TEST CERTIFIED BY- r Phone: Date <br /> OBSERVED BY(REHS): / Phone � v ff Date &/ a <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />