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SAN JOAQUIN COUNTY <br /> 0�4 Pe <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HAENT SE AVE $PHONON,91 68-31 <br /> ••� 1"...k�i�� 95205 <br /> DEVELOPMENP SERVICES PHONE 8091 468-]120 <br /> PLANNING PHONE 12091 468.3120 <br /> BUILDING PHONE 12091 468.3123 <br /> NEIGHBORHOOD PRFSERVA71ON PHONE 2091 468-3021 <br /> BACKFILL EXCAVATION CERTIFICATES / <br /> Project Location 5 / !�_ <br /> Owner KlJn Phone No. -51d Pyr <br /> Contractor — � Phone No. SD'/5/72`/0/ License Nc . /�30�✓�� <br /> INDICATE METHOD OF BACMM;- QUALITY ASSURANCE <br /> !/ 1. Submission of soil Encineer'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 is <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 Eng'ineer'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 (S) rabic vards 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 /> Title ( rint) <br /> �s i'gniture <br /> Shall be the responsible- managing emolovee on the license or authorized <br /> acent. <br /> 6/91—LC/BECERT.DOC <br />