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C,.F" In. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: ;{ <br /> • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> '4��FOR <br /> (� !, PERCOLATION TEST RATE 4 i- <br /> ADDRESS OR LOCATION: I V 1 'lr.L 4l A CITY: �{`D C� �O✓� <br /> OWNER NAME: JILA1.u1M1 Mnd 4- �71x ,` DATE: 2 <br /> APN: a0b 0 4 0 -L 7 APPLICATION#: �L Z Q�1 V U DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: i„/;,i ,ra� y,,ic)l•! ;E S <br /> REMARKS: <br /> E , <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES <br /> i <br /> - <br /> E <br /> L l <br /> ; E <br /> tE.' <br /> E <br /> E <br /> 7—E <br /> , <br /> - <br /> E ` <br /> : E IDS{ <br /> [� <br /> _ l . _ _ �f T-1.- 711 <br /> ET <br /> 1 <br /> _ - - <br /> — y� <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Type _Depth Soil Type Depth Soil Type Depth oil Type De th Soil Type <br /> Test Hole# 1 _ Test ole#2 <br /> Parcel: Diameter: in De .th"L P arcel: Diameter: in De the <br /> TIME 41READI G WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> r � � O 11 � 'V C/ •V <br /> PERCOLATION RATE: .._ min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC,#REA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: I (Ol t y- C-OLOOLA Phone: '17' .1 °�'LI LDate t t Z- <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(REHS): �(/l� Phone Date rP <br /> EHD 42-03 REV 11/2/09 <br /> PERC TEST RATE FORM <br />