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®rk <br /> SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810EHAZELTON AVE., STOCKTON.CA 95205 <br /> DEVELOPMENT SERVICES PHONE 12091 468-3120 <br /> PLANNING PHONE 12091 4687120 <br /> BUILDING PHONE:12091 4683123 <br /> NEIGHBORHOOD PRESERVATION PHONE: 12091 468 3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 4245 E. MAIN STREET, STOCKTON, CA 95215 <br /> owner MR lArIC ERANCTSM Phone No. (703) 780 53/2 <br /> FALCON ENERGY phone No. (209) 46571U8 License, No. 584524 <br /> ContractorAHAZ <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 /> completicn 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 /> bk 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 /> * �sTck FiQf��ii/U�Sca <br /> Name (Print) <br /> Title Print) <br /> )-a* <br /> Sign ture <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />