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SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> w < <br /> 1610 E.HAZELTON AVE.,STOCRTON CA 95205 <br /> OEVELOPMENT SERVICES PHONE 12091 468 3120 <br /> PLANNING PHONE,12091 468 3 S 20 <br />' WILDING PHONE.(2091 466 3123 <br /> NEIGHBORHOOD PRESENYATION PHONE 12091 466 3021 <br />' BACKFILL EXCAVATION CERTIFICATE <br /> roject Location Riverside Cement Co. 2825 W. Washington St Stockton, Ca. 95203 <br /> Owner <br /> Riverside Cement Co. Phone No. (209)9148-0520 <br />'Contractor Jim Thorpe 0i1, Inc phone No. (209)368-6175 License No. 495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1 Submission of Soil Engineer's compaction Report within 30 days of project <br /> completion, or <br /> IX 2 Submission of verification, e.g. load ticket, within 30 days of project <br /> completion that one of the following materials was placed in the excavation in <br /> 12" lifts: <br /> X A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> a <br /> Inch in diameter. <br /> B. Crushed rock -- self-compacting material not more than three-quarters <br /> I (3/4) inch in cross sectional measurement. (Use of crushed rock <br /> will not be permitted for backfill if contact will be made between <br /> 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 <br /> of project completion, or submission of verification that the select material described above <br /> will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and i <br /> that the entire excavation will be backfilled and compacted to insure compliance with the <br /> Uniform Building code Appendix chapter 10. <br /> Richard Thorpe <br /> IName (Print) <br /> Contractor <br /> T i Trin <br /> Signature <br /> Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> P6/91-LC/BECERT.DOC <br /> I <br />