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.*SAN JOAQUIN COUNTY <br />r.''. � COMMUNITY DEVELOPMENT DEPARTMENT <br />'' 1810 E HA WON AVE. STOCKTON• CA 95205 <br />...0 41AE'a`�\• DEVELOPMENT SERVICES PHONE 1209) 468.3120 <br />PLANNING PHONE 1209) 460-3120 <br />BUILDING PHONE 12091 468-3123 <br />NEIGHBORHOOD PRESERVATION PHONE (209) 468-3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project LocationOO I � I l_k X. j <br />Owner J e Phone No. �� �p b :4 <br />Contractor lvL SC l4' 1tA,)1 foakAwe No. "3(,7 lA a!3 License No. �g <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 />_Z/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 />- <br />�' 9-ame (Print) <br />Title (Pri <br />* <br />ignature <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />