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San Joaquin County <br /> Community Development Department <br /> 1810 E. Hazelton Avenue. Stockton.CA 95205 <br /> Development Services Phone: (2(N)469-3120 <br /> Planning Phone: (209) 468-3120 <br /> Building Phone: (2(X1)-169-3123 <br /> Neighboncuxxh Preservation Phone: (20))W-3021 <br /> BACKFILL EXCAVATION(7ERT(FICA'IE <br /> Project Location L.LNL S 1 lmr ,:b.D. V)9 <br /> Owner L L N L _Phone No. S)O-(-a3- 9 111 <br /> Contractor —PETmoi fag-. PhoneNo.`IOJ-gS-SJ-%;n License No. SCIGA55 <br /> INDICATE METHOD OF BACKFILL Q(.;ALITY ASSURANCE <br /> 1. Submission of Soil Engineers Compaction Report within 30 days of project completion.or <br /> 2. Submission of veriticAtion.e.e..load ticket.within 30 days of project completion that one of the following <br /> materials was placed in the excavation in 12"lifts: <br /> A. Pea_ravel-smooth.rounded material not more than one-half(112)inch in diameter. <br /> B. Crushed rock-sell'-compiming material not more amn three-quarters(314)inch in cross sectional <br /> measurement. (t Ise of crushed ruck will not he permitted for backfill if contact will be made <br /> between the backfill material and tanks/pipes mace of poly resin glass or similar materials.) <br /> DECLARATION <br /> CI hereby certify that a Soil Engineers Compaction Report will be submitted within 30 days of project completion.or <br /> submission of verification that the select material described above will be placed at a minimum of five(5)cubic yards per <br /> 100()*a! tank displacement and that the entire excavation will be backfilled and compacted to insure compliance with the <br /> Uniform Buildin_Code Appendix Chapter 70. <br /> Fan p N ATfPiLi, <br /> Naune(Print) <br /> N5 n,oc-T10h3 YYIANAV4l1. <br /> Title(Print) <br /> S ienauure <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> 6/91-LC/BECERT.DOC <br /> 12 <br />