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/aHld, <br /> SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E.IUZELTON AVE..SNOCKION.CA 95205 <br /> (�lN r'iSN i, DEVELOPMENT SERVICES PHONE: 1209)4683120 <br /> PLANNING PHONE:(2091 4683120 , <br /> BUILDING PHONE: 1209)4683123 <br /> NEIGHBORHOOD PBESEDVAvoN PHONE.12091 4683021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 25-16 ZVO CAT Q�Cf/��7� �icr�cyT r� <br /> Owner�7`, Imo:: 'i?l/� if6 V40 one No(:2c/r <br /> Contractor ,,»r.r �-,C ,,$hone N —License No. C / jl�(CN �z <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project. <br /> ---- completion, or <br /> \/ 2. submission of verification, e.g. load ticket, within 30 days of project- <br /> completion that one of the following materials was placed in the excavation In <br /> 12"lifts: <br /> ✓ A. Pea gravel - smooth, rounded material not more than one-half ( I /2) <br /> Inch In diameter. <br /> _ B. Crushed rock - self-compacting material not more than three-quarb;.ru <br /> (3/4) inch in cross sectional measurement. (Use of crushed ru.,I, <br /> will not be permitted for backfill if contact will be made beCwuuu <br /> the backfill material and tanks/pipes made of poly resin glasa ur <br /> similar materials. ) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 dayu <br /> of project completion, or submission of verification that the select material described abovla <br /> will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement slid <br /> chat the entire excavation will be backfilled and compacted to insure compliance with th.. <br /> Uniform Building Code Appendix Chapter 70. <br /> Name rint) <br /> WX* <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-1,C/BECERT.DOC ' . <br />