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SAN JOH .JIN COUNTY PUBLIC HEALS SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION LAND USE TRACKING LOG <br /> LAND USE # -60-/ 3 ADDRESS 5V 7 7 , ZAIcz A <br /> SURFACE - SUBSURFACE CONTAMINATION REPORT: SR# <br /> DATE RECEIVED DATE STAFF ACCEPTED REPORT: <br /> PROGRAM ELEMENT (� 3� APN: OY "/00-- ;7 <br /> CONDITIONS OF APPROVAL: YES,ZNO_ DATE SATISFIED PERMIT/SR# INITIAL <br /> GENERAL HEADING: CT DATE: 5 � <br /> A. <br /> B. <br /> C. <br /> D. <br /> E. <br /> F. <br /> G. <br /> H. <br /> 1. <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 />