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.*SAN JOAQUIN COUNTY <br />a;. "�� <br />r�. :.s COMMUNITY DEVELOPMENT DEPARTMENT <br />`� 1810 E HAMTON AVE, STOCKTON. CA 95205 <br />��(i fppN�' DEVELOPMENT SERVICES PHONE 12091 4663120 <br />PLANNING PHONE (2091468-3120 <br />allLpNG PHONE 1209) 468-3123 <br />NEIGHBORHOOD PRESERVATION PHONE 1209) 4683021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location <br />kLr�G <br />Ste, lam- <br />LA \C(A g5Zo(� <br />Owner <br />V\N.1G <br />Phone No. <br />(Sio) 'i 6-3364 <br />Contractor F-Nv. Sucs-Lac. Phone No.�ckg 033-0955 License No. 16SI-TO <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 />* <br />* <br />* Shall be the responsible managing emp49yee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />