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co <br /> . ±'.!n.•� SAN JOAQUIN COUNTY <br /> °�c�•o <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> " 1 1610 E WELTON AVE.STOCKTON.CA 95205 <br /> ' ri •Ti�dT'�� DEVELOPMENT SERVICES PHONE 12091 468.3120 <br /> PLANNING PHONE:12091460-3120 <br /> BUILDING PHONE:(209)460-3123 <br /> NEIGHBORHOOD PRF-SERVATION PHONE:(2091 460.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> 1r � <br /> Project Location 51 1 _pf)CI � '� -J�J��LYD �` , 00'2 <br /> owner r �r�, 3 ;� 1_ rA L� ",c Phone No. So a <br /> Contractor i.JS z-- i�4 Phone No. �tG' ��!°� a License No. <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 <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 Sail 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 /> ic <br /> er <br /> will be placed' mnt and <br /> axcavationmwill fbeebackfilled and dccmpactedOtoainsure llon acompliance nk ewith the that the entire ee <br /> Uniform Building Cade Appendix chapter 70. <br /> 1 <br /> Name (Print) <br /> Title int) <br /> Sign re <br /> Shall be the responsible managing employee on the license or authorized <br /> 1 agent. <br /> t6/91.-LC/BECERT.DOC <br />