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C <br /> SAN JOAQUIN COUNTY <br /> .� <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HA2ELTON AVE, STOCKTON, CA 95205 <br /> Ci l;.;3.. r DEVELOPMENT SERVICES PHONE{209) 466-3120 <br /> PLANNING PHONE 1209) 468-3120 <br /> BUILDING PHONE.)209)468-3123 <br /> NEIGH80RHOOD PRESERVATION PHONE (209)468.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location "!fn ?_ S <br /> e <br /> owners Phone No. 04v?-2Z2 <br /> Contractors S hone fof <br /> No.c,4c�-E��-33� License No, <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 /> 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 /> Name (Print) <br /> c <br /> ' tle ( int) <br /> Signatu <br /> Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />