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.*SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT E <br /> 1810 HAZELTON AVE. STOCKTON.CA 95205 _ <br /> • c{^ ? DEVELOPMENT SERVICES PHONE 1209 468-3120 <br /> IXB'a <br /> PUNNWG PHONE 12091 468-0120 <br /> SUgDING PHONE:(209(468-3127 <br /> NEIGHBORHOOD PRESERVATION PHONE (2091 468-3021 <br /> BACRFILL EXCAVATION CERTIFICATE <br /> Project Location 2q wESx 1 ST2&E7-- TRACY CA a5 379 <br /> Owner CrU oA77RAcy. Phone No. z@� - 836 - /-/'/ZD <br /> Contractor WkL6NT e1VVLA6AJAEArWPhone No.7/1-833-o7SR License No. 6S/S6/ <br /> S zcrS / LWC. <br /> / INDICATE METHOD OF BACRFILL 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 /> 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 /> * J C)HA) r-. L v is � <br /> Name (Print) <br /> Pk-tSSOCA)T <br /> T le (Print) <br /> S1 nature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />