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a�RY�+n. � SAN JOAQUIN COUNTY <br />>. �.,.ffo �.o <br />r.' = COMMUNITY DEVELOPMENT DEPARTMENT <br />1910 E HAZELTON AVE., STOCKTON. CA 95205 <br />c+ lyo�r`� DEVELOPMENT SERVICES PHONE 12091 469.1120 <br />PLANNING PHONE 12091 468-3120 <br />SULDING PHONE 12091 468.3123 <br />NEIGHBORHOOD PRESERVATION PHONE (2091 468-3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project <br />Location <br />5000 So. Airport Way, Stockton, California <br />Owner TIS <br />nanartmani- <br />of Transpnrtation Phone No. _916-551-3406 <br />CnntrnCi=nr <br />Arnncr.n <br />121111. T11". Plinno h10, o1(_,in1-16nnT.iconco <br />Mn, <br />x,02010 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />1 1. <br />Submission <br />of Soil Engineer's Compaction Report within '30 <br />days <br />of project <br />completion, <br />or <br />2. <br />Submission <br />of verification, e.g. load ticket, within 30 <br />days <br />of project <br />completion <br />that one of the following materials was placed in <br />the excavation <br />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 />* Shall be the responsible managing <br />agent. <br />6/91-LC/BECERT.DOC <br />Name (Print) <br />Rcs 1 <br />loyee on the license or authorized <br />