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SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> f8io E HAZELTON AVE.STOdOOK CA 95105 <br /> ...•r•l�6ai+�• DEVlNNG PHONE SUMCE14�NE 12091 468.3120PLA . <br /> BUILDING PHONE 12091 468.3173 <br /> NEIGHBOHH000 PPESERVATION PHONE(2091 468-JDZI <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location (pSC� � drsff�-(�ITpIP 7��e <br /> Owner ftTyig Al rA-tCAP,)f 1/(51 CIO Phone No.L 2Z7111 q-7?7 D PrP <br /> Contractor <br /> S'Ein6e Phone No.tafR /6S3 License No. �WeZ <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 /> oad <br /> ithin <br /> 2 completion that one of the following lmate materials was wo <br /> submission of verification, e.g. placed in the project <br /> 12" lifts: <br /> V-'IA. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> inch in diameter. <br /> S. 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 /> T le Print) <br /> nature <br /> * Shall be the responsible managing employee on the license or authorized <br /> i <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />