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.aw!a SAN JOAQUIN COUNTY <br /> Uzi COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E WQELTON AVE.,STOCKTON.CA 95205 <br /> • r�!lP da��' DEVELOPMENT SERVICES PHONE (209) 4683120 <br /> PLANNING PHONE(209)4683t20 <br /> BUILDING PHONE 12091 4683123 <br /> NEIGHBORHOOD PRESERVATION PHONE 1209)468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 816 E. HAZELTON AVENUE, STOCKTON, CA %203 <br /> Owner ESTATE OF HICKINBOTHAM, ET.AL. Phone No. (209) 465 5628 (AGENT, ATTORNEY <br /> DUSContractor JAMES HOBLITZELL COE <br /> Phone No.(2U9)y43 7793 License No. 365234 <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 was placed in the excavation in <br /> 12" liftsl <br /> X A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> OIL 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 /> Name (Pr <br /> ln <br /> Tlt e� rintj <br /> lgnature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br /> Pa06 13 <br />