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VT".. SAN JOAQUIN COUNTY <br />r.. COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E HAZELTON AVE. STOCKTON, CA 95205 <br />ifd-di+i DEVELOPMENT SERMM PHONE 1209) 468-3120 <br />PLANNING PHONE 12091 468-3120 <br />BUILDING PHONE (209) 468-3123 <br />NEIGHBORHOOD PRESEMA71CN PHONE (209) 468.3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location Bldg. 647 - Sharpe Depot <br />Owner DDRW Phone No. 209-982-2094 <br />Oil Equipment 2pg <br />Contractor SPrvir.a Phone No. 754-1808 License No. 323417 <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 />X 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 />X 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 />*Keith A. Tallia <br />Name (Print) <br />Presiden <br />�t e Print <br />/.Tigna-tued <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91—LC/BECERT.DOC <br />