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�e n. SAN JOAQUIN COUNTY <br />' <br />o COMMUNITY DEVELOPMENT DEPARTMENT <br />• <br />IB IO E HAZELTCN AVE, STOCKTON. CA 95205 <br />C�tl'r Snr:`� <br />DEVELOPMENT SERVICES PHONE 12091 468-3120 _ <br />PUNNING PHONE 12091468-3120 <br />BUILDING PHONE (209) 468-3123 _ <br />NEIGHBORHOOD PRESERVATION PHONE (2091468-3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location AZO S, 1-0C*5-1_60 ST, i (fWM <br />Owner 1�'lpb&' M IW Jul(- Phone No. (you %�- 1 it - quo -7 <br />Contractor <br />,eE,n GO <br />Phone No.ZafRf 1�-_5 License No. <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 />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 />�A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br />inch in diameter. <br />Crushed rock - self -compacting material not more than three-quarters <br />(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 <br />that the entire excavation will be backfilled and compacted to insure compliance with the <br />Uniform Building Code Appendix Chapter 70. <br />JA& -L-, tt,, <br />Name (Print) <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />691-LC/BECERT.DOC <br />