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Q,,4!'_•.n. SAN JOAQUIN COUNTY <br /> �' =? COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E HAZELTON AVE-STOCKTON.CA 95205 <br /> ��tiFo'n��r 0EVELOPMENT SERVICES PHONE(2091 468-3120 <br /> PLANNING PHONE(2091 468-3120 <br /> BUILDING PHONE(2091 468.3123 <br /> NEIGHBORHOOD PRESERVATION PHONE(2091 468.3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> ry <br /> Project Location � pro <br /> 1 N cc ow <br /> Owner s ew OIL, COMPANY Phone No. ( ✓X 01 (p-7 S �� ¢� <br /> - � ' F Phone No4, 10).�47-2�f8�1 License No. -432103 <br /> Contractor �' . �'�' <br /> WzK ST" <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 /> fA. 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 /> vim cle <br /> 9Name (Print) <br /> I <br /> _ T e r <br /> * <br /> ' gnatur <br /> * Shall be the responsible managing employee on the license or authorized <br /> ate. <br /> 6/91-LC/BECERT.DOC <br />