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San Joaquin County • �� �� <br /> Community Development Department <br /> 1810 E. Hazelton Avenue. Stx)ckton.CA 95205 <br /> Nvelopment Services Plume: (2(X))-tC,tt-t12u <br /> Planning Phone: (2(M)) 36R-31211 <br /> Building Phone: (209)369-3123 <br /> Neightxirhoxxl Preservation plx)ne: (2(M))-469-3(121 <br /> BACKFILL EXCAVA'rioN CERTIF'ICA'TE <br /> Project Location LLN L S 4 W r--.,-by l Lz� V)9 <br /> Owner LLN L _Phone No. <br /> Contractor f TTLOT LX-- -Phone No.4-019-S YM License Nei. S°lQac1S <br /> INDICATE METH()I)OF BACKFILL QUALITY ASSURANCE <br /> 1. Suhmission of Soil Engineer's Compaction RM)n within 3O days of project completion,or <br /> _ 2. Submission of verification.e.__.,load ticket.within 30 days of project completion that one of the following <br /> materials was placed in ttte excavation in 12"lifts: <br /> %A A. Pea gravel-snuxxh.rounded nuaerial nut more than one-half(112)inch in diameter. <br /> _ B. Crushed rock- It'-cump�Ktim:material cx►t more that three-quarters(313)inch in cross-sectional <br /> measurement. 0 Ise of crushed rock will not be permitted for backfill if contact will be made <br /> between tate backfill material antJ t:utks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> 1 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 /> 1000 gallon tank displacement and that the entire excavation will be backfilled and compacted to insure compliance with the <br /> Uniform Building Code Appendix Chapter 70. <br /> �n N �Trk PI <br /> Name(Print) <br /> CDNSTrwc-T1OX) YYIAf�AC�SJ1. <br /> Title(Print) <br /> Signature <br /> Shall be the responsible managing employee on the iicceme or autlumzed agent. <br /> 6/91-LC/BECERT.D(K <br /> 12 <br />