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SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> m: <br /> 1910 P_HAZELTO <br /> N AVC-.8TOCKrON,CA V5205 <br /> DEV OPNIENT SERV10E3 HNE:(20 0)488.3120 <br /> PLANMNG PHONE;(209)468.9120 <br /> OUIL04NO PHONE:(209)480.3123 <br /> NE50HOORHOOD PRESERVATION PHONE:(204)40-3o21 <br /> BACKFILL EXCAVATION CERTWICATE <br /> Project Location Valley Showcase, 901 W. Fremont St., Stockton, CA 95203 <br /> Owner George Leclxlch Phone No. (209) 4665777. <br /> Contractor JIM THQRPI~ OIL CO,, INC, Phone No. (209)-3686175 License No. 495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> Submission of Soil Engineer's Compaction Report within 30 days of project <br /> completion, or <br /> X 2. Submission of verif'tcation,e.g.,load ticket, within 30 days of projeet comm lotion <br /> that one of the following materials was placed in the excavation in 12" lifts: <br /> X A. Pea gravel -- Smoth, rounded material not more than one-half (112) inch in <br /> diameter. <br /> B. Crushed rock -- self compacting material not more than three-quarters (314) <br /> inch in cross sectional measurement. (Use of crushed rock will not be <br /> permitted for backfill if contact will be made between the backfill material and <br /> tanks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> [ hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project <br /> completion, or submission of verification that the select material described above will be placed at a <br /> minimurn of five (5) cubic yards per 1000 gallon tank displacement and that the entire excavation will be <br /> backfilled and compacted to insure compliance with the Uniform Building Code Appendix Chapter 70. <br /> RICHARD THO PE <br /> Name (Print) <br /> Preside <br /> T' Prin <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized agent, <br /> 6r 'I-�CMECERT,DOC <br />