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r_ _ <br />SAN JOAQUIN COUNTY <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E HAZELTON AVE, STOCKTON. CA 95205 <br />DEVELOPMENT SERVICES PHONE )209) 4683120 <br />PLANNING PHONE )209) 4683120 <br />BUILDING PHONE )209) 4683123 <br />NEIGHBORHOOD PRESERVATION PHONE )209) 4683021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location F( 2c TA _11 ON h4 7 o C <br />Owner C a F S I OC Ob K) Phone No. �0 9 937 8 0 �kQ c� <br />Contractor Q 1 Cs7 t C 7EC � Phone No,�b? q5'6 `i 0M License No. 3S8 <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 (1/2) <br />inch in diameter. <br />XB. Crushed rock - self -compacting material not more than three-quarters <br />V <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 />* kA( E-CTrc. 76CA /uL <br />Na (Print) <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />