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[�] ❑ 4.2 Description/discussion of any existing and/or potential groundwater contaimination issues in the general location of the site. [l� ❑ 4.3 Description of location (address/APN), type and construction of well and location (well head/kitchen tap) where water sample(s) were obtained. [r] ❑ 4.4 Description of constituents being tested for in the water sample. \ALh`-k t j"Sr�Ti l� eQ [7f F-14.5 Description of how sample was obtained, handled, stored, and transported to the lab. [❑ 4.6 Complete Chain of Custody document, including printed and signed name of third party sampler, condition of sample and date and time the sample was submitted to the lab. For Laboratory samplers, complete laboratory report to include the above noted information. 5.0 SOIL PROFILE INFORMATION SECTION [� ❑ 5.1 Site map showing the location, with dimensions, of the soil profile pit on the parcel. F� ❑ 5.2 Description of soil profile pit including depth and dimensions. 7 ❑ 5.3 Description of soil lithology as noted from test pit by appropriate professional using industry standard protocol. Ed ❑ 5.4 Discussion of soil lithology as related to future onsite septic uses. S I 6.0 PERCOLATION TEST INFORMATION SECTION [�f ❑ 6.1 Site map showing the location, with concise and accurate dimensions of the percolation test holes on the parcel. 17 ❑ 6.2 The minimum number of shallow and deep percolation tests was performed for each parcel. E� ❑ 6.3 Description of the date, time and protocol used to prepare the test hole, including depth and dimensions of hole, preparation of hole, and depth of water used to presoak (minimum 12 inches). E� ❑ 6.4 Description of the date, time and condition of the test hole after the 24-hour soak period (hole still intact, hole dry, depth to water remaining in hole, etc.) [!f ❑ 6.5 The test conformed to SJC Policy EHD 02-02 (correct depth, diameter, 2" gravel, 6" water refill, correct readings recorded). [f] ❑ 6.6 Complete Percolation Test Form (including readings) was provided with REHS verification signature. The rate was correctly calculated using the last reading. [7� ❑ 6.7 Discussion of any potential problems predicted and/or the need for an engineered or alternative septic system. [j] ❑ 6.8 Discussion of percolation rates in relation to the type, size and location of future leach fields needed at the site. 7.0 CONCLUSION SECTION E� ❑ 7.1 The report was signed and stamped by the appropriately registered individual Reviewed By: Reviewed Date: b 0 C ' �21)22 EHD 26-02-003 Page 2 of 2 Soil Suitability Checklist 7/14/2003