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San joaauin County • <br /> ommunity Deveiopment De Eartment <br /> 1810E Hazelton Avenue Stockton,CA 95205 <br /> Development Services Phone: (209)468-3120 <br /> Planning Phone: (209) 468-3120 <br /> Building Phone: (209)468-3123 <br /> Neighborhood Preservation Phone: (209)468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location __LLNL Site 300 Building 871 871-D1U1 Closure <br /> ----------------------------------- <br /> Owner -= TN1- _1« Phone No. (510) 423-4881 <br /> ---------------------------------- <br /> Contractor _--Irans.Qu_Engineering------Phone No. (916) 381-160bcenseNo. 592010 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> I. Submission of Soil Engineer's Compaction Report within 30 days of project completion,or <br /> H _. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the <br /> following materials was placed in the excavation in 12" lifts: <br /> X A. Pea gravel -smooth, rounded material not more than one-half(1/2) inch in diameter. <br /> B. Crushed rock-self-compacting material not more than three-quarters(3/4)inch in cross <br /> sectional measurement. (Use of crushed rock will not be permitted for backfill if contact <br /> will be made between 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 of project <br /> completion, or submission of verification that the select material described above will be placed at a minimum <br /> of five (5) cubic yards per 1000 gallon tank displacement and that the entire excavation will be backfilled and <br /> compacted to insure compliance with the Uniform Building Code Appendix Chapter 70. <br /> . "�RonlSanl E�G /NEE�ING � TnIL, <br /> Name (Print) <br /> e� 5ojc:�*JT <br /> Title (Print) <br /> Si azure <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> 6/91-LC/BECERT.DOC <br /> 13 <br />