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e IK. SAN JOAQUIN COUNTY <br /> r.'''�y�,,y COMMUNITY DEVELOPMENT DEPARTMENT <br /> —� •• 1810 E WZELTON AVE STOCI(TON.CA 95205 <br /> • c�"yy 'M`� DEVELOPMENT SERVICES PHONE(2091 268.3120 <br /> PLANNING PHONE 1209)268-3120 - <br /> BUOD9VG PHONE(2091 268.3 f 23 <br /> NEIGHBORHOOD PRESERVATION PHONE 1209146a.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location /D I,UcSi t kANr L rAjL kb Aa %kAeV &4 f5_3 74s <br /> Owner L L Z ZZ dE TRAC Phone No. <br /> Contractor Gl32Z6NT rN�l/�A�/MfA/lePhone No. z6y-533-07 License No. 6S/ 0/ <br /> JF�IJrceS� r/VL <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 /> 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 /> * )o N� Al YA)ChH <br /> Name (Print) <br /> PAG=S.r,0t5�er/F_ <br /> Ti e (Print) <br /> 15 nature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />