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NRu n. SAN JOAQUIN COUNTY <br /> —� � COMMUNITY DEVELOPMENT DEPARTMENT <br /> - - •� 1870 E HAZELTON AVE STocaoN.0A 95205 - <br /> -"•��a•A OEVEI.OPM@rt SERVICES PHONE 8491 4683120 _ <br /> M AMANG PHONE(2091468-3120 <br /> 8=1NG PHONE(2091468-3123 <br /> NEiGH80RHOOD PRESERVATION PHONE(2091 1683021 <br /> BACYFILL EXCAVATION <br /> rCERTIFICATE <br /> Project Location 'qSrO$ S . Nd✓CCK cX rv�e-(A 6U1401 4fz2( <br /> Owner /(/�M 1>r- l-1 Phone No. (Zz7J) `1$Z'1�77j <br /> Contractor YEinee Phone No.ZOysZSly6S3 License No . �eZ3r� <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 fallowing 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 /> _ 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 Cade Appendix Chapter 70. <br /> Name (Print) <br /> T le (Pri ) <br /> * kt <br /> gnature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />