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' BACKFILL EXCAVATION CERTIFICATE <br /> Project Location: Northeast corner of Farmington Rd and E Mariposa Rd Stockton, CA <br /> Owner Walgreens Phone No: 650-689-5073 <br /> Contractor:All Chem Phone No: 510434-9200 <br /> License No:599864 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 7f1. Submission of Soil Engineer's Compaction Report within 30 days of project <br /> completion, or `TSL�5 ;s Fo- r- -6.:e <br /> � s,,,\3 days <br /> C l�F <br /> 2. Submission of verification, e.g), load ticket, within 30 days of project completion that <br /> one of the following materials was placed in the excavation in 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 will <br /> not be permitted for backfill if contact will be made between the <br /> backfill material and tanks/pipes made of poly resin glass or similar <br /> 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-Era". Pos <br /> Fin <br /> ' Title <br /> � / nn <br /> ' Signature-�n . ( �. <br /> ' `Shall be the responsible managing employee on the license r,bVthorized agent. <br /> OCT 2 6 4wt <br />