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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location: Northeast corner of Farmington Rd and E Mariposa Rd Stockton, CA <br /> Owner Walgreens Phone No: 650-689-5073 <br /> Contractor:All Chem Phone No: 510-434-9200 <br /> License No: 599864 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> r' 1. Submission of Soil Engineer's Compaction Report withir� 30 days of project <br /> completion, orso',1 �- - <br /> � �"(� <br /> 2- Submission of verification, e.g), load ticket, within 30 days of project completion that <br /> one of the following materials was placed in the excavation in 12" lifts: <br /> A. Pea gravel--smooth, rounded material not more than one-half (112) <br /> inch in diameter <br /> B. Crushed rock--self-compacting material not more than three-quarters <br /> (314) inch in cross sectional measurement. (Use of crushed rock will <br /> not be permitted for backfill if contact will be made between the <br /> backfill material and tanks/pipes made of poly resin glass or similar <br /> 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 /> *Name Frank R. POS _ <br /> nn <br /> Title <br /> (print) <br /> Signature ��. . <br /> *Shall be the responsible managing employee on the license or authorized agent. <br /> OU 2 6 2011 <br /> SAN JOA,i:;"q cojjiv . <br /> ErgvIRorwMEN AL <br /> i; ^!TP 0FV,,,TArEil{ <br />