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SAN JOAQUIN COUNTY <br /> o <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HAZELTON AVE..SfOCKTON,CA 95295 <br /> r ��r <br /> DEVELOPMENT SERVICES <br /> 1795 PHONE ,(209) 468.3120 <br /> pRING PHONE- <br /> BUIl41NG PHONE,(2091468-3123 <br /> NEJGH90RHO00 PRESERVATION PHONE(209)468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location X-Me- -70 / 5Ti2E <br /> Owner �U � �'� r�J6 CD P Phone No <br /> Contractor ! 'CAC0 Phone No.Zo� 66-1 License NO. W?961 <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 /> Name (Print) <br /> ES/�, /ltATp/Z <br /> Title (Print) <br /> LAS <br /> signature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECEAT.DOC <br />