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z-a <br /> SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> `� • 1810 E WELTON AVE..STOCKTON.CA 95205 <br /> i •yu.b aL DEVELOPMENT SEnVK:ES PIIONE: 12091 4604120 <br /> PLANNING PHONE:12091 460.3120 <br /> BUILDING PIIONE:12091460-3123 <br /> NEIGHBOD11000 PnESEIIVAIION PIIONE:(2091468-3021 <br /> DACXFILL EXCAVATION CERTIFICATE <br /> Project Location A/00 L V/ C <br /> Owner 'D,427 CCJ,4/%;}//,rt (ZPllone No! Zcc> <br /> Contractor L---eto LP ro, (.,,,C_ , Phone No . License No. CJS/US 1� <br /> INDICATE METHOD OF DACKFII.L QUALITY ASSURANCE <br /> _ .1. Submisslon of Soil Engineer's Compaction Report within 30 days of project <br /> completion, or <br /> A/ 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" liftel <br /> �l <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 /> DECLAMATION <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 /> 'Pit _ (Prin - - <br /> Si.gnatu .e <br /> �l* Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/DECERT.DOC <br />