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SAN JCr;KQUIN COUNTY PUBLIC HEAv=TH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION LAND USE TRACKING LOG <br /> LAND USE #--,;A-9 `� ADDRESS l b <br /> SURFACE - SUBSURFACE CONTAMINATION REPORT: SR# <br /> DATE RECEIVED DATE STAFF ACCEPTED REPORT: <br /> PROGRAM ELEMENT APN: Z-Zq <br /> CONDITIONS OF APPROVAL: YES_ NO_ DATE SATISFIED PERMIT/SR# INITIAL <br /> GENERAL HEADING: DATE: <br /> B. It ' U3 <br /> C. 01 <br /> D. OZ <br /> E. <br /> F. <br /> G. <br /> H. <br /> I. <br /> J. <br /> REVISED CONDITIONS (DATE/COMMENTS): <br /> SOIL SUITABILITY/NITRATE LOADING LETTER: DATE INIT <br /> WATER RESULTS WARNING LETTER: DATE INIT <br /> OCCUPANCY SIGN OFF: DATE INIT <br /> SURVEYOR LETTER: DATE INIT <br /> SAMPLING RESULTS: <br /> NITRATE DBCP <br /> EDB ARSENIC <br /> OTHER OTHER <br /> OTHER OTHER <br /> PERCULATION TEST RESULTS: <br /> HOLE # HOLE DEPTH PERC RATE (MIN/IN) PASS/FAIL <br />