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O��FAr, SAN JOAQUIN COUNTtCOMMUNITY DEVELOPMENT DEPARTMENT <br /> 1610 E WQEUON AVE.SIOCx10N•CA 95205 <br /> OEVEIOM.IEW SEm9CES P"MF-12091 4663120 <br /> 14- N PIG MIMIC'12091 460-3120 <br /> MKOM MIONE:1209)•1663123 <br /> NEVIDOMIOCO MIESEMAnON F400M 12091 460.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> ��ot <br /> Project Location 714 N. Filbert St. Stockton, CA 95-336 <br /> Owner Ramsey Real Estate Development Phone No. (209)466-8733 <br /> Contractor Jim Thorpe Oil, Inc. Phone No. (209)368-6175 License No. 495699 <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 /> X 2. Submission of verification, e.g. load ticket, within 30 days of project <br /> completion that one of the following materials wag placed In the excavation In <br /> 12" llft"I <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 1 <br /> the backfill material and tanks/pipes made of poly resin glass or ' <br /> similar materials. ) <br /> DECLARATION <br /> I Thereby 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 /> Jim Thorpe Oil, Inc. <br /> Name (Print) <br /> Contractor <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />