Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HAZELTON AVE.STOCKTON.CA 95205 <br /> • �`�••... .'int• DEVELOPMENT SERVICES PHONE (209) 468.3120 r <br /> PLANNING PHONE(2091 468.3120 <br /> BUILDING PHONE 1209) 468.3123 <br /> NEIGHBORHOOD PRESERVATION PHONE (209) 468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 35aS I AY V PIZ-Iyl,;� <br /> Owner pSGd >FIN16-s Phone No. <br /> ' ��-- <br /> Contractor�fJ4�l, � �, 'o. �.�i�!Ur., Phone No. L/ic> nse 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 /> _ Submission of verification, e.e load ticket, within 30 days of project <br /> comple ion that one of the follW ing materials was placed in the excavation in <br /> 12" efts: <br /> A. Pea gravel - mooth, rounded material not more than one-half (1/2) " <br /> inch in di eter. <br /> _ B. Crushe ock - self-compacting material not more than three-quarters <br /> (3/4) inch in cross sectional measurement. (Use of crushed rock <br /> wil not be permitted for backfill if contact will be made between <br /> t backfill material and tanks/pipes made of poly resin glass or <br /> imilar materials. ) <br /> DECLARATION <br /> I hereby certify t t a Soil Engineer' s Compaction Report will be submitted within 30 days <br /> of project comple on, or submission of verification thathe select material described above <br /> will be placed a minimum of five (5) cubic yards pe ' 1000 gallon tank displacement and <br /> that the entir excavation will be backfilled and compActed to insure compliance with the <br /> Uniform Build' g Code Appendix Chapter 70. <br /> 1. <br /> * <br /> Na e Pr n <br /> Titi (P in ) <br /> * Y <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />