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BACKFILL EXCAVATION CERTIFICATE <br />Project Location 4032 North E1 dorado Street , stockton ca <br />Owner Bob Eustis Phone No- 709 47-4-ormi <br />Contractor AGE Phone No. 467-1006 License No. 680227 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />.,"2. Submission of verification, e.f. load ticket, within 30 days of project completion that one of the following materials was <br />placed in the excavation in 12 lifts: <br />✓A. Pea gravel—smooth, rounded material not more than one-half (I 2) inch in diameter <br />B. Crushed rock—self-compacting material not more than three- (314) inch in cross sectional <br />measurement.(Use of crushed rock will not be permitted for b if contact will be made between the <br />backfill material and tanks/pipes made of poly resin glass or similar materials.) <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30s ofprojec[ completion, or submission of <br />verification that the select material described above will be placed at a minimum of five (5) cubic yazds per 1000 gallon tank <br />displaceatem and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br />Appendix Chapter 70. <br />* Shall be the responsible managing employee on the license or au[Worlud agent. <br />onvTo <br />SEP 15 1998 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />