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RECE � VED <br /> BACKFILL EXCAVATION CERTIFICATE SEP 2 8 2016 <br /> Project Location : 540 North El Dorado Street , Stockton , CA 95203 ENVIRONMENTAL HEALTH <br /> Spaulding Trust Property Owner DEPARTMENL <br /> Phone No : <br /> Contractor : Advanced GeoEnvirornTnental , Inc . Phone No :_ <br /> License No : 680227 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1 . Submission of Soil Engineer' s Compaction Report within 30 days of project <br /> completion , or <br /> X 2 . Submission of verification , e . g . , load ticket , within 30 days of project completion that <br /> one of the following materials was placed in the excavation in 12 " lifts : <br /> A . Pea gavel - -smooth , rounded material not more than one - half ( 1 /2 ) <br /> inch in diameter <br /> X B . Crushed rock--self- compacting material not more than three - quarters <br /> ( 3/4)) inch in cross sectional measurement . ( Use of crushed rock will <br /> not be permitted for backfill if contact will be made between the <br /> backfill material and tanks/pipes made of poly resin glass or similar <br /> 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 /> * Name <br /> William Little <br /> tint <br /> Title geologist <br /> tint <br /> Signature <br /> "Shall be the responsible managing employee on the license or authorized agent . <br />