Laserfiche WebLink
`,e ..W <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location <br />Ralph's Market, 2122 S. Airport Way, Stockton, CA 95206 <br />owner Ralph Lee White Phone No. <br />Contractor_ <br />Owner, Phone No. , same as above License No. n/a <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br />kCJ 7 j , was placed in the excavation to IT lifts: <br />®�p� (1�,tW A. Pea gravel --smooth, rounded material not more than one-half (1/2) inch in diameter <br />S <br />�� 1 _ B. Crushed rock--self-compactin material not more than three-quarters (3/4) inch in cross sectional <br />v a mesuremet. (Use of crushei rock heabackfillnmaterial and tanks/pipes wmade of poly ill not be rresindglass for bor similar ackfill if omaterialsntact ! be made between <br />) <br />DECLARATION <br />1 hereb�yy certify that a Soil Engineer's Compaction Report will be submitted within 30 da s of roject completion, or submission <br />of verititation that the select material described above will be placed at a minimum of tive (5cubic yards per 1000 gallon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br />Code Appendix Chapter 70. <br />Ralph Lee White <br />ame ( tint) <br />• Shall be the responsible managing employee on the license or authorized agent. <br />