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R Vin. SAN JOAQUIN COUNTY <br />COMMUNITY DEVELOPMENT DEPATITME JT <br />1910 E 11AZELTON AVE. STOCKTON• CA 95205 <br />i0b* �r DEVELOPMENT SERVICES PHONE (2091 ACM -1120 <br />rtmr m F11oNE: (2091 460.9120 <br />nUILOING Pt10NE: 12091 460.3123 <br />NEIG1(ROR11000 PTIESERVATION PHONE (2091 460-1021 <br />DACKFILL EXCAVATI-Ott CERTIFICATE <br />Project Location <br />Owner I�l��(l1� �„�fi i'lTotTo ilo . �a -�� ,�� . s { ��" <br />COntraCtor 1 �1�'l�IL�L���1L �r��1, 1')lonn llrt.LRA 5k -IU -b- Ito. <br />INDICATE MTHUD OF BACKFILL, QUALITY ASSURANCR <br />1. Submission of Soil Engin-er's "-p()rt wi-h.hi_n 30 days of prnjnct <br />completion, or <br />- 2. Submission of ver.ific_ation, -.q. best t:icLnt, wi.thi.n :30 mays of pr••j^ck, <br />completion that one of the foil-owinct maters-alrt was pl.acod i.n the nxclvation in <br />12" lifts - <br />\J A. Pea gravel - smooth, rokitided material not morn than one -•half (1/7) <br />Inch in diameter. <br />e. Crushed rock - self--compacti.rnq matnrinl not morn than thr.en-quarters <br />(3/4) inch in cross sectional measurement. (Use of crushed rock <br />will not be permitted for backfill if contract wi.l.l. be made between <br />the backfill material and tanks/pipes made of poly resin glass or <br />similar materials.) <br />DECLARATION <br />1 hereby certify that a Soil Engineer's Compaction Report will be'submitted within 30 days <br />of project completion, or submission of verif icat *-on that the set Pct material descr. i bed above <br />will be placed at a minimum of five (5) cubic ynrcln per. WOO Mallon tank displic—mmnt and <br />that the entire excavation will be backfilled and compact-] L-, insure compliance with thn <br />Uniform Building Code Appendix Chapter 70. <br />tlattte (1:'T:-intj <br />Title (Print) <br />P <br />JiAlg is ure—-- <br />* Shall be the responsible managing employee an the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />