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Address: 211 Waudman Avenue <br />SR0083409 <br />y'�y1�- IODD as a <br />y`g- ` Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.$)gov.org/ehd <br />• �4ZIP 6'a+�+F <br />PERCOLATION TEST RATE <br />ADDRESS OR LOCATION: X11 ILZ11.4y" f U6 CITY: <br />OWNERNAME OI-�Phr.K f /`y }p 1.1 lyl/ DATE: 2 z- <br />APN: APPLICATION k:DEPTH TO FIRST WATM '�O F <br />SOIL TYPE: e-. J + F)d.J A;-I'�..0/I I--�.. c.lt+„/...A 7_2 '7_� i /J.-<-- - Y <br />Test Hole #1 Test Hole # 2 <br />Parcel:. Diameter: in De the in Parcel: Diameter: In De the in <br />�►rc�n� <br />P.WMM <br />PERCOLATION KAI t:: I r, <br />RECOMMENDED SEPTIC EA: <br />PERFORMED BY: <br />ERTIFIEI BY: <br />PERCOLATION RATE: <br />RECOM DE RE <br />Phone: D Da <br />Phone: Data <br />ck1=(� 3 sIk Date <br />Phone <br />Naseem Ahmed, Registered Environmental Health Specialist <br />080.290-M <br />ft 1u"M <br />