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CKFILL EXCAVATION CERTIFICATE <br /> Project Location 1645 Cherokee Rd. , Stockton CA 95205 <br /> Owner Central California Traction Co. Phone No. (209)466-6927 <br /> Contractor Jim Thorpe Oil , Inc . Phone No. (209)368-6175 License No. 495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 3c 2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials was <br /> placed in the excavation in 12" lifts: <br /> X A. Pea grave!--smooth, rounded material not more than one-half(I/2) inch in diameter <br /> B. Crushed rock—self-compacting material not more than three-quarters (3/4) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfin if contact will be made between <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of pproject completion, or submission of <br /> verification that the se!ect material described above will be placed at a minimum of five (5) cubic yards per 1CC0 gallon tank <br /> displacement and that the entire excavation will be back;lled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> * Jim Thor e Oil e <br /> ame nnt) <br /> Co;, ctor <br /> t rm <br /> * <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />