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SAN � 10 A Q U I N Environmental Health Department <br />- COUNTY <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location: 1601 E. HAZELTON AVENUE, STOCKTON CA <br />Owner SAN JOAQUIN CO PUBLIC HEALTH SERVICES Phone No: 20946&3411 <br />Contractor: RB ENVIRONMENTAL INC <br />License No: 747572 <br />Phone No: 209-932-0606 <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 />X 2. Submission of verification, e.g., load ticket, within 30 days of project,comletion <br />that one of the following materials was placed in the excavation in 12' lifts: <br />A. Pea gavel --smooth, rounded material not more than one-half (1/2) <br />inch in diameter <br />X B. Crushed rock--self:compacting material not more than three- <br />quarters (3/4) inch in cross sectional measurement. (Use of <br />crushed rock will not be permitted for backfill if contact will be made <br />between the backfill material and tanks/pipes made of poly resin <br />glass or similar materials.) <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 <br />days of project completion, or submission of verification that the select material <br />described above will be placed at a minimum of five (5) cubic yards per 1000 gallon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure <br />compliance with the Uniform Building Code Appendix Chapter 70, <br />Title <br />Sign <br />*Shall be the responsible managing employee on the license or authorized agent. <br />