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OKFILL EXCAVATION CERTIFICATE • <br />Project Location <br />650 E, MINER AVENUE, STOCKTON, CA 95202 <br />Owner JAGENDER SINGH Phone No. (209) 466 9082 <br />Contractor <br />JIM HOBLITZELL PhoneNo�209) 9437793 License No. 365234 AHAZ _ <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />2. Submission of verification, e.�., load ticket, within 30 clays of project completion that one of the following materials was <br />placed in the excavation in 12 lifts: <br />f A. Pea gravel --smooth, roundtd material not more than one-half (1/2) inch in diameter <br />iti B. Crushed rock—self-compacting material not more than three-quarters (3/4) inch in cross sectional <br />ackfill if <br />the backfill nt. (Use of crushed rock will not be material and t.utks/pipes made of poly resin glass or ermitted for similarr materials.) be made between <br />DECLARATION <br />Compaction Report will be submitted within 30 <br />I hereby certify that a Soil Engineer's days of pproject completion, or submission of <br />verification that the select material described above will be placed at a minimum of five (5) tabic yards per 1000 gallon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br />Appendix Chapter 70. <br />• JAGENDER SINGH <br />ame not <br />* OWNER <br />u e rent <br />r C ti �y <br />tgnamre <br />" Shall be the responsible managing employee on the; license or authorized agent. <br />