Laserfiche WebLink
ea,.. SAN JOAQUIN COUNTY <br /> ' ( �- r.•�,' �+�.c COMMUNITY DEVELOPMENT DEPARTMENT <br />�fi �� w• a <br /> + 1010 E HAZELTON AVE..STOCKTON.CA 95205 <br /> ••• YHd+�. DEVELOPMENT SERVICES PHONE(2091 4603120 <br /> PLANNING PIKINE(2091468-3120 <br /> BUILDING PHONE(2091 468 3123 <br /> NEIGHBORHOOD PRESEINATION PIIONE (2091 46a-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location gy� � Glf�2�f� 14Gi �fUc ro �J4 <br /> Owner Phone No. <br /> Contractor Simu,).!S� Grq FSG �Phone No Thy �{6V�3�3 License No. "e5%j lam✓ <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 /> V,.-/ <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" jXfte: <br /> � {/_/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 /> Name (Print) <br /> PI 'le 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 />