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BACKFILL EXCAVATION CERTIFICATE I, <br /> 4025 Coronado Avenue, Stockton, CA 95204 <br /> Project Location (209)AAA-1477 <br /> Owner <br /> J.H. Simpson Company Phone No. <br /> Contractor JIM THORPE OIL INC. Phone No. (209)368-6175 License N0.495699 <br /> INDICA'T'E ME111013 OF BACKFILL QUALITY ASSURANCE Ii <br /> _ 1. Submission or Soli Engineers Compaction Report within 30 days of project completion, or <br /> X 2, Submission n[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" II[Is: <br /> X A. Pea gravel--smooth, rounded material not more than one-half(1/2) inch In diameter . <br /> _ B. Crushed rock--self-compactI ick <br /> in material not more than three-quarters (3/4) Inch in cross sectional <br /> between <br /> (or backfill if <br /> tmeasurement. Usearcrushm r( <br /> he backfill materi I and tanks/pip swmade of polyrresindglass or similarontact materialswil. a materials.)) <br /> DECLARATION i <br /> 1 hatch certify That a Soil Engineer's Compaction Report will be submllied within 30 days or roject completion,or submission <br /> of verification that the select material described[above will be placed at a minimum or five(5�cubic yards per 1000 gallon lank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br /> Code Appendix Chapter 70. <br /> f JIM THORPE OIL,INC. <br /> ame r nt) <br /> f COME 0 <br /> t <br /> f <br /> igt e <br /> f Shall be the responsible managing employee on the license or authorized agent. <br /> ` I <br /> ' IIS <br /> I� <br /> i <br /> II <br />