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.*SAN SAN JOAQUIN COUNTY <br /> s�' �{� COMMUNITY DEVELOPMENT DEPARTMENT <br /> •�. " •� 1510 E K42ELTON AVE.STOCKTON•CA 95205 <br /> 2• .�� • DEVELOPMENT SERVICES PHONE 12091 468.3120 <br /> PLANNING PHONE 12091 4663120 <br /> BUILDING PHONE 12091 468-3123 <br /> NEIGHBORHOOD PRESERVATION PHONE 12091 4683021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location �S r�L / CCS l?L)^(i ��1S�TC�� C�>` J/ C4 <br /> Owner�{���N�— Phone No. <br /> Contractor-5, <br /> ontractorX „ , ,{`y� Z'.Thone No. qLicense <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 /> 4Z__�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 /> V 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 /> Name_ (Pr nt) <br /> T tle ( int.) <br /> S c'na ure <br /> * ' Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOCI <br /> 1 � . <br />