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o,a _n.,� SAN JOAQUIN COUNTY <br /> z '1 COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1010E HAZELTON AVE.. 670CKION,CA 95205 <br /> DEVELOPMENT SERVICES PHONE 12091 460-3120 <br /> • ��fll d*�` PLANNING PHONE 12091 460,3120 <br /> BUILDING PHONE: 12091 460 3123 <br /> NEIGHBORHOOD PRESERVATION PHONE 12091468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 1651 Louise Ave. Lathrop,Ca. 95330 <br /> Owner Cocrunercial Transfer Inc. <br /> Phone No. (209)983-0233 <br /> Contractor Jim TJLsrpe Oil Inc. Phone No. (209)36 8-6175 License No .49569_ 9 <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 /> X 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 /> 47-- inch <br /> rounded material not more than one-half (1/2) <br /> A. Pea gravel - smo <br /> inch in diameter. <br /> ters <br /> B. Crushed rock - self-compacting material not more0eeaofhan hcrushed rrock <br /> — (3/4) inch in cross sectional measurement. <br /> will <br /> not <br /> be lpermitted <br /> and tanks/pip s made Ill if contact <br /> poly bresin eglasseor <br /> for backf b <br /> the <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 /> s per <br /> will bethat thepentireaexcavationmwillfbeebackfilled anddcompacted0toainsurellon acompliancenk ewith the <br /> Uniform Building Code Appendix Chapter 70. <br /> * Richard Thorpe <br /> Name (Print) <br /> President Jim ThorLe Oil 1 <br /> T' (Pr in <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />