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San Joaquin County <br /> Community Development Department <br /> 1810 E.Hazelton Avenue,Stockton,CA 95205 <br /> Development Services Phone: (209)468-3120 <br /> Planning Phone: (209) 468-3120 <br /> Building Phone: (209)468-3123 <br /> Neighborhood Preservation Phone: (209)468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location LLNL Site 300 _Building 871 871-DIU1 Closure <br /> --------------------------------------------------------- <br /> Owner ------Phone No. (510) 423-4881 <br /> -------------------------------------- <br /> Contractor _-ArQgaQ Engineering___-__PhoneNo. (916) 381-160(bcenseNo. 592010 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion,or <br /> X 2. Submission of verification,e.g., load ticket, within 30 days of project completion that one of the <br /> following materials was placed in the excavation in 12" lifts: <br /> X A. Pea gravel-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 <br /> sectional measurement. (Use of crushed rock will not be permitted for backfill if contact. <br /> will be made between 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 of project <br /> completion, or submission of verification that the select material described above will be placed at a minimum <br /> of five (5) cubic yards per 1000 gallon tank displacement and that the entire excavation will be backfilled and <br /> compacted to insure compliance with the Uniform Building Code Appendix Chapter 70. <br /> •A Ro tq 5o,1 EIJG f N�Efz��I G 7-n1G, <br /> Name (Print) <br /> feeT <br /> Title (Print) <br /> • l . <br /> Si ature <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> 6/91-LC/BECERT.DOC <br /> 13 <br />