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SAN JOAQUIN COUNTY <br /> r' a COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1610 E WQELTON AVE. STOCKTON.CA 95205 <br /> • ri 11 d'd*1i`� DEVELOPMENT SERVICES PHONE 12091 4680120 <br /> PLANNING PHONE 12091468-3120 <br /> BUILDING PHONE 12091 4680120 <br /> NEIGHBORHOOD PRESERVATION PHONE 12091 466 0021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 101 W. Charter Way, Stockton, CA <br /> Owner Ron Shelan Phone No. (209) 576-7501 <br /> Contractor Jim Thorpe .0il , Inc. Phone No. (209) 462-4581 License No. 495699 <br /> dba Rich-Mart Constr. <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" llftel <br /> X A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> Inch in diameter. <br /> B. Crushed rock - self-compacting material not more than three-quarters <br /> (3/4) inch in cross sectional measurement. (Use of crushed rock <br /> will not be permitted for backfill if contact will be made between <br /> the backfill material and tanks/pipes made of poly resin glass or <br /> similar materials. ) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br /> of project completion, or submission of verification that the select material described above <br /> will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and <br /> that the entire excavation will be backfilled and compacted to insure compliance with the <br /> Uniform Building Code Appendix chapter 70. <br /> * Martin Thorpe <br /> Name (Print) <br /> Vice-President <br /> Title (Print) <br /> Signature �� T <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />