Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT ovARTMENT <br /> Mt t <br /> 1410 E HAZELTON AVB.,STOCKTON.G1 9sz09 <br /> !k OEV OPMENT SERVICES PHONE:(2091 485 3120 <br /> PLANNING PHONE(2091 468 3120 <br /> BUIIOING PHONE(209) 466.3 t23 <br /> NEiiFf BOFHOOD PAESEWATION pHpNp (208) 498 3021 <br /> BACKFILL EXCAVATION CERTXPXCATE <br /> Project Location Z-6 5 N, <br /> owner /45- E3d A P_4K6 Phone No. <br /> FLUORDh�1C-L CY_r—mA-ijcojsvcr.4,�r -410)30-39go 455 52 <br /> C411tZ'FaCtox' W,A, C-AhK 4KNc..T. .f Tf,�l,Phone No. 0 Z5Z-3 s� License No . _ WDA, C,Q�I4 <br /> - c .gas, z,1�, — F,1,Z ccr-�Qk"0-J 4 cF wall cQ�ra <br /> Rr�+��c,4 rro,✓ <br /> A' iNUicAiE KEiR6L &T BACKFILL QUAL117 Aa=�su`'Cz <br /> Zh 1. Submission of Soil LrnQin8Gr' S Compaction Report within 30 days of project <br /> 2. Subm'SSLon of verification, e.g. load ticket, within 30 days of project <br /> _._.. -_ _ _- �- - --- - <br /> _ �.c .. mow„ __ <br /> ---- -- a ••• �• a •,aa rel s.-.c�.i f .. the rax�xvAt-i f�rf ifl <br /> 12" Lifts. ` <br /> A. pea gravel - smooth, rounded material not more than one-tial£ (1/2) <br /> inch in dygmoter. <br /> $. Crushed rock - self-compacting material not more than three-quarters <br /> .Lit C_LU%*W <br /> will not ba permitted for backfill, if contact will be made between <br /> the backfill, material and tanks/pipes made of poly resist glass or <br /> similar mat:erzals ) <br /> DECLARATION <br /> I hereby certify that a Soil. Engineer s Compaction Report will be submitted within 30 days <br /> Of praject campletLon, Of sunmiesion 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 backfLlled and compacted to insure compliance with the <br /> Uniform Building Code Appendix Chapter 70 <br /> Title (Pri.nt) <br /> Signature <br /> * Shall be the respoilsible managing employee on the license or authorized <br /> agent <br /> /91--LC/8CCERT nac <br />