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N) (Tinian) (Rota) Or deliver by hand to: DEQ office on island where test is located 1. Site Location Diagram (sketch map and/or directions) 2. Estimated Schedule: Pre-soaking will begin: Date Percolation test will begin: (estimate) Time Date Time 3. Client Information Owner name Project name / type 4. Percolation Tester Percolation tester name & signature Date Certification number DEQ form version 7.18.07 CNMI DIVISION OF ENVIRONMENTAL QUALITY PERCOLATION TEST REPORT Title Pa.

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