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SAN JOAQUIN COUNTY <br />COMMUNITY DEVELOPMENT DEPARTMENT <br />•• � I810 E K42ELTON AVE, STOCKTON. CA 95205 <br />%BA+ DEVELOPMENT SERVICES PHONE 12091 4663120 <br />PLANNING PHONE 12091 4683120 <br />BUILDING PHONE 12091468-3123 <br />NEIGHBORHOOD PRESERVATION PHONE 12091 4683021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location --500 e. F�EMI�NT ST ST OCKTON, CA �752/S <br />Owner <br />Phone No. 209 - 94848/ 7 <br />Contractor WESTE A MF7,45�02 SV(,_,Phone Pto. qZ� �C4 <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 clays 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 />* l'LnnlARN cgls> <br />Name (Print) <br />�71Ems_ U PT. <br />T tle (Print <br />fi In <br />f-gn2fture <br />* Shall be the responsible managing employee on the license or authorized <br />agent. ; <br />6/91-LC/BECERT.DOC <br />