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�gi.4u.. •. cA SAN JOAQUIN COUNTY <br />r COMMUNITYL T DEPARTMENT <br />101510011010101 W. :< <br />„ I.s 1810 E. HAZELTON AVE., STOCKTON• CA 95205 <br />DEVELOPMENT SERVICES PHONE: (209' 468.3120 <br />PLANNING PHONE 12091468-3120 <br />BUILDING PHONE (209( 468.3123 <br />NEIGHBORHOOD PRESERVATION PHONE: (209) 468.3021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location 1 t�C\L 1'i (' �a �� Lir i # � ___ L, �k o <br />Owner a `�e� Phone No -� <br />Contractor C r, t„ a Phone No. (�P, ` � License No • c( ( <br />CNDICATE METHOD OF QUALITY <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 />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 <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 />li '• <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 of . (5) cubic yardsper iii gallon tank displacement and <br />that the entire excavation will be backfilled and compacted to insure compliance with the <br />Uniform • Code Appendix Chapter0. <br />Name ( int) <br />Itle (P intj <br />Signature,' <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />