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San Joaquin C=)unty 0 00005o <br /> Community Da ,;elopment Department <br /> 1810 E. Hazelton Avenue. Stockton.CA 95205 <br /> Development Serv!ces Phone: (2(1'))W-3120 l <br /> Planning Phone: (2th)) .469-3120 <br /> Buildin,Phone: (209)46X-3123 <br /> Neighborhood Preservation Phone: (209)46X-3021 <br /> BA('KFILL EXCAVATION CERTIFICATE <br /> Project Location (-.LWLN S ITL 300 ZU U-3)NG 105' <br /> Owner LLN L Phone No. S-)'7 — �-la3_41; <br /> Contractor L Phone No.(411-ti53`)` b License No. r7 ")''.,; 1 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineers Compaction Relxrt within 30 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 the excavation in 12"lifts: <br /> A. Pea ertvel-smooth.rounded material not more than one-half(1/2)inch in diameter. <br /> B. Crushed rock-self-compacting material not more than three-quarters(3/4)inch in cross sectional <br /> measurement. (I Ise of crushed rock will not be permitted lir backfill if contact will be made <br /> between the backfill materialand nd tanks(pipes made of poly resin glass or similar nutterials.) <br /> I)l:(7_ARA'IT()N <br /> I hereby certify that a Soil Engineer's Compaction Repon will he submitted within 30 days of project completion.or <br /> submission of verification that the select material described atxwe 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 die <br /> Uniform Building Code Appendix Chapter 70. <br /> S� l;TT'K.f.�v�'i �P' <br /> Name(Print) <br /> C.t�>a S'�dLllC.'D 10 <br /> Title <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> 6/91-LC/BECERT.DOC <br /> 12 <br />