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" 0002 Ai <br /> San Joaquin County <br /> Conurtunl Dowel nr-nt De arttnent <br /> 1810 E.Hazelton Avenue,Stockton.CA 95205 <br /> Development Services Phone: (209)468-3120 <br /> Planning Phone: (2D9) 468-3120 <br /> Building Phone: (209)468-3123 <br /> Neighborhood Preservation Phone: (209)468-3021 <br /> BACKFEL EXCAVATION CERTIFICATE <br /> Project Location u-N L �J lTg. 3 U� 13 sgAzra 1 N l= $;L9 D 01 U 1 <br /> owner- LL N L Phone No. S)O - 4 013 " 91V <br /> j <br /> Con `t.T r O T jtt_ Phone No.LJo'%—453-I`13$� License No. <br /> INDICATE NWMOD OF BACIMLL QUALM ASSURANCE <br /> X 1. Submission of Soil Engineei s Compaction Report within 30 days of project completion.or <br /> 2. Submission of verification,e.g.,load ticket.within 30 days of project Completion that one of the following <br /> materials was placed in the excavation in 12"rifts: <br /> A. Pea gravel-smooth.rounded material not more than orae-half(1/2)inch in diameter. <br /> _ B. Cmished rock-self wmpacting material riot mot than threie-quarters(3/4)inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be made <br /> between the backfill material andtanks/pipes made of poly resin glass or similar .) <br /> L' DECLARATION` <br /> I hereby certifythat a Soil Engineer's Compaction Reportwill be stibmitted within 30 days of project completion,or <br /> submission of voification 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 /> . �ctZD �i�i 1 s -�r°nIPEaz <br /> N (Print) <br /> Wv-os-TrwCalahl mglvA 4v► <br /> Tide(Print) <br /> S gr== <br /> Shall be the responsible managing employee on the license or audiorized agent <br /> 6/91-LC/BECERT.DOC <br /> 12 <br />