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r. <br /> � r <br /> u'•n• SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 18 t o E HAZEL70N AVE,STOCxTON,G 45205 <br /> r�ti�d'd�A* OEVELOPMENT SERVICES PHONE(209) 468-3120 <br /> PLANNING PHONE:(2091 468-3120 <br /> BUILDING PHONE(209(468-3123 <br /> NEIGHBORH000 PRESERVATION PHONE(2091 468.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 8115 South E1 Dorado Street, French Camp, California 95231 <br /> Owner Mr. James Fisk Phone No. (209) 982 0897 <br /> Contractor Elite IV Contractors,In�hone No. (209) 461 6337 License No. 660076 A,B,C-10 <br /> Haz <br /> INDICATE HETHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer' s Compaction Report within 30 days of project <br /> completion, or <br /> Z. 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 /> AA. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> oR 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 permit`-ed 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 Compacticn 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 ccmpacted to insure compliance with the <br /> Uniform Building Cade Appendix Chapter 70. <br /> Lim rjpgnn <br /> Name (Print) <br /> Cnntrartnr X nWnar'q Anont <br /> Title (Print) <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 91-LC/3ECERT.0CC <br /> (3. <br />