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r..{ <br /> SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> '- 1810 E.HAZELTON AVE. STOWON.CA 95205 <br /> DEVELOPMENT SERVICES PHONE: X2091 468-3120 <br /> PLANNING PHONE (209)468.3120 ,�A N 3 0 192 <br /> BUILDING PHONE: (209)468.3123 <br /> NEIGHBORHOOD PRESERVATION PHONE (209) 468.3021 CNViRQNMENTA!_ HEA;.Tt.i <br /> PERMIT/SERVICES <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location Uj � <br /> Owner A �i,(464e,e T Phone No. <br /> ContractorPhone No.T d License No. <br /> -!�' <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> I. 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 /> y 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 /> *_J4?,077e6 J, <br /> Name (Print) <br /> e 4a <br /> i e (P i ) <br /> * <br /> Signa e <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />