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rte ' 11RR is '93 03123PM.ULqMgR INC, • P. 13/16 <br /> I <br /> 9AN JOAQUIN COUNTY <br /> e; "-r�l•s COMMUNITY DEVELOPMENT DEPARTMENT <br /> Saa�IIsIA :i <br /> 1010 E.WELTON NVB„STOCKTON,:A 90205 <br /> DEVELOPMENT SEIMCES PHONE 12001 155.3120 <br /> PLANNINO PHON412081155.3120 <br /> BUILDING PHONa 12091456-3123 <br /> NEIGHBORHOOD PRESEWATION RMQN@ (2091 400-3031 <br /> BACKZILL EXCAVATION CERTIFICATE <br /> m <br /> Project Location 23 rc Loo 2 D <br /> Own ar UL TR A, lM Dnz r :T5;;c c. Phone No. 2, O°t - -S'P 3 - S-S"�f z <br /> contrtactor CIuLAs.,,,Phone N0. fly -3±z (0' License No. 8' <br /> INDICATE METHOD OF RACXFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's compaction Report within 30 days of project <br /> "— complation, 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 /> 1211 liftss <br /> A. Pea gravel - smooth, rounded material not more than one-halt (1/2) <br /> inch in diameter. <br /> S. Crushed rock - self-compacting material not more than those-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 mads of poly rsain glass or <br /> similar materials.) <br /> DECLARATION <br /> I hereby certify that a Soil Enginaerls 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 /> ML C4A-FL <br /> Name (Print) <br /> Rrz. L FJ- e <br /> gnature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />