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BACKFILL EXCAVATION CERTIFICAT,,/ <br />Project Location 442 N. Air Port Way, Stockton, CA 95205 <br />Owner Raymond Lopez Phone No. (029)462-0253 <br />Contractor Jim Thorpe Oil, Inc. Phone Vo. (209)368-6175 License No. 495699 <br />INDICATE 'METHOD OF BACKFILL QUALITY ASSURANCE <br />L Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />X 3. 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 l'_'' lifts: <br />g A. Pea gravel--imooth, rounded material not more than one-half (1/2) inch in diameter <br />B. Crushed rock—se!f-compacting material not more than three-quarters (3/4) inch in cross sectional <br />measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between <br />the baclaill material and tanks/pipes made of poly resin glass or similar materials.) <br />DECLARATION <br />1 herebv certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project completion, or submission of <br />verification that the select material described above will be placed at a minimum of Five (5) cubic yards per I" gallon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure comoliance with the Uniform Building Code <br />Appendix Chapter 70. <br />* Jim Thorne-Tn. by Riohnrd Ttc1pe <br />Name I rF-intl <br />* <br />Conty4ctor <br />Title i ^ t <br />Signature <br />* Shall be the responsible managing employee on the license or authorized agent. <br />