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...,*SAN � SAN JOAOUIN COUNTY <br />1 0 <br />�!� COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E HAZELTON AYE• STOCKTON. CA 95205 <br />• r{tiKap��� DEVELOPMENT SERVICES PHONE (2091466-3120 <br />PLANNING PHONE 12091468-3120 <br />BUILDING PHONE 12091468-3123 <br />NEIGHBORHOOD PRESERVATION PHONE 12091 468-3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location 5i11\1 ru 22vrsS- -As c`���` \6 <br />Owner 8rf61A o� l�'�s, T_, ve5rr r� r ��� Phone No. <br />Contractor �� �I.a Phone Pto. q/( -)-3`7Z. 7q4icense No. a�1I�2�/ <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 />V" 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 />V' 13. 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 />Name (Pr t) <br />Li <br />Title (Pri t) <br />Signa re <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />