Laserfiche WebLink
f 1 BACKFILL EXCAVATION CERT'IFICAT'E f <br /> i <br /> Project Ia)cation 2449 W. Kettleman Lane, Lodi, CA 95242 <br /> �4 <br /> I <br /> Owner -_- --- James Anagnos -- - - Piihone No. (209)333-10.'3r <br /> Contractor JIM 'THORPE OIL, INC. Phone No. (209)368--6175,1 License No.495699 <br /> INDICATE MF-TlIOO OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report witldn 30 days of project completion, or <br /> X 2. Submission of vetlfIcallon, e.g., load ticket, within 30 days of project corInplellon that one of the following materials 1 <br /> was placed in the excavation in 12" lifts: 1 <br /> X A. Pea gravel--smooth, rounded material not more than one-half(1/2) Inch In diameter <br /> B. Crushed rock--self-compacting material not more than three-quarters (3/4) Inch 1n cross sectional <br /> measurement. (Use of crushed rock will not he permitted for backfill If contact will be made between <br /> the backfill material and tanks/pipes made of poly resitil glass or similar materials.) <br /> li <br /> DECLARATION <br /> I lictchyy certify that a Sett Engineer's Contpaclton Report will he submitted within 30 do s of troject completion,or submission <br /> of vctificalion 11181 the select ntalerial described above will be placed at a minintotni of flue(5�cubic yards per 1000 gallon tank <br /> displaccrttent and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building ! <br /> Code Appendix Chnpter 70. <br /> • JIM THORPE OIL,INC. <br /> Name (Print) f <br /> • CONTRACT& <br /> le rill <br /> Signature <br /> f <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> i <br /> I <br /> I ' <br /> 1 <br /> i <br /> F <br />