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,oq:Q �lY: SAN JOAQUIN COUNTY <br /> s ENVIRONMENTAL HEALTH DEPARTMENT <br /> yyjj ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> '. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: /9 OI CA-r;fe X6 Qt! CITY: /,TD rlLTOtj q z(.S <br /> OWNER NAME: t��OS�Lf 7�/�22 E DATE:Jr -U4 K l S, ZOZ4 <br /> APN: 009 APPLICATION#: DEPTH TO FIRST WATER: �OD� Ft <br /> SOIL TYPE: P rz- <br /> REMARKS: NO STANDI&4 V/A7rk -rZ- a, JJZ <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> I � I <br /> - — - —I <br /> I [ I I I 1 1 I � I <br /> -- -- - <br /> LH - 1 <br /> i --, n_ i <br /> II j <br /> [a] , _ _--I <br /> , • <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Tye Depth Soil Type Depth Soil Tye Depth Soil Ty Qe Depth Soil Type <br /> Test_Hole# 1 _ Test Hole#2 <br /> karcel: p Diameter: in I Depth: ( in Parcel: ^Diameter: in T Depth: in <br /> 2.3F <br /> TIME READING WATER DROP REFILLED TI READING WATER DROP REFILLED <br /> � --- - <br /> �2 <br /> 0-2 ,S ' <br /> a 3 o a Zo <br /> : o 02;. ' 2- <br /> PERCOLATION RATE: l 02 S min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC A A: F O RECOMMENDEgSEPTIC AREA: <br /> TEST PERFORMED BY: Phone: .20 f 2-lG f2 Date a2 — $�- <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY (REHS): Phone (P49) (01�Q M Date 21 S /2& 1 p <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />