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aura. SAM JOAOUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HAMTON AVE STOCKTON.CA 95205 ' <br /> •Id-syr` DEVELOPMENT SERVICES PHONE 1209 468-3120 <br /> PLANMNG PHONE(2091 468-3120 - <br /> BUBDING PHONE 12091 468-3123 <br /> NEIGHBORHOOD PRESERVATION PHONE(2091 468.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location iSZoo S C.940SAAA1t% tZD CA <br /> Owner �i?.4i-y GAF �3'•u ,KPtP L1WV5 Phone No.(Zt ' ) <br /> Contractor Ye�,n Phone 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 /> V_"A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> inch in diameter. <br /> B. 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 /> 1ItN me (Print) <br /> e Print) <br /> * <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />