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tau n. SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> a <br /> d 1810 E HAZELTON AVF-SrCCKrON•CA 95205 <br /> ••"•T�d p'r� DEVELOPMENT SERVICES PHONe 12091 468.3120 . <br /> PLANNING PHONE 12091468-3120 <br /> BULGING PHONE 12091468-31n <br /> NOGHSORH000 PRESERVATION PHONE(2091468-3021 <br /> BACKFILL ESCAVATIONNCERTIFICATE <br /> Project Location VOK A62ttkM P"" 2rMe__JrV <br /> q' <br /> Owner (,v1( rw!F*rkc. Phone No.(ZVei) q-7 95' '/ <br /> Contractor S'EinGO Phone No.ZoySZ�{cjyS3 License No. WY 941 <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 /> >E L, rLI�G•�-f��► <br /> Name (Print) <br /> 4T1"ePr int) <br /> Y11nat—ure <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />