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.TIM. THORPE. OIL. INC 209 368 1851 P. 02 <br /> r� r <br /> SAN JOAOUIN COUNTY <br /> ""'f�1.1 COMMUNITY DEVELOPMENT DEPARTMENn. T' <br /> ram <br /> •: Isla E IWILTCN AVE,710087 c"ss 940 <br /> -1 pEyrlopmod1&6w�Lr4 PION!�1 <br /> P11NR10 rmmrB t"I 458J1" <br /> MUtnMlO MJoW(NDI 468-3123 <br /> P&GHB MODO PI NWAI ON mioHE law 469-7MI1 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 101 W. Charter Way, Stockton, CA <br /> Owner <br /> Ron Shelan Phone No. (209) 576-7501 <br /> contractor <br /> Jim Thorpe.01 , Inc. phone No. (209) 462-4591 License No. 495699 <br /> dba Rich-Mart Constr. <br /> IIIDICATE METHOD OF BACXPII.f. QUALITY ASSURAHCH <br /> i. submission of Soil Englneer's compaction Report within 30 days of project <br /> —' completion, or <br /> 2. Submission of verification, 0.9. load <br /> ticket, withiIn the excavas of kioject <br /> atarlala <br /> "-' completion that one of the following was placed <br /> In <br /> 12" lifts, <br /> X A. Fels gravel - smooth, rounded material not more than one-half (1/2) <br /> inch In diameter. <br /> tOrg <br /> B. Cush(3/ e self-compacting <br /> inch in cross tl al material �r <br /> measurement- (Use hhec <br /> of crushed 4) sectional 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 /> DHCLARATION <br /> I hereby certify that a Sol, Kngtneer•s Compactlon Report will he submitted within 30 days <br /> o[ project completion, or submission of verification that the select materia, described above <br /> will be placed at a minimum of five (5) cubic yards per loco gallon tank displacement and <br /> that the entire excavation will be backfilled and compacted to Insure compliance with the <br /> uniform Building code Appandix Chapter 70- <br /> k Martin Thor e <br /> Name (Pr n ) <br /> Vice-President <br /> Title (Print) <br /> Signature <br /> + shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/H8C8RY-bOC <br />