Laserfiche WebLink
BACKFILL EXCAVATION CERTIFICATE <br /> ProJectLocation 550 W. Charter Way,Stockton, CA 95206 <br /> Don Rodgers Phone No. (209)465-7515 <br /> Owner <br /> I <br /> Contractor JIM THORPE OIL INC. Phone No. (209)368-6175 License No.495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> I <br /> _ L Submission of Soil Engineer's Compaction Report within 30 days of project completion,or <br /> X 2. Submission o(verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br /> was placed in the excavation in 12" lifts: <br /> X A. Pea gravel--smooth, rounded actingmaterial not more than one-half(1/2) inch in diameter . <br /> uarters <br /> inch <br /> sectional <br /> B Crushed mea.urem-no. (Use of crushed rock will not be permitted for bMaterial not more than ackfill if contact w011be made between <br /> the backfill material and tankstpipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I hereb certify that a Soil Engineer's Compaction Report will be submitted within 30 da of rojeci completion,or submission <br /> of verification that the select material described above will be placed at a minimum of five(4 cubic yards per 1000 gallon tank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br /> Cotte Appendix Chapter 70. <br /> • JIM THORPE OIL,INC. <br /> ame rnt) <br /> • CON'1'RAC <br /> Ile t <br /> • I <br /> ign ure <br /> " Shall be the responsible managing employee on the license or authorized agent. <br /> i <br />