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„ .-.CKFILL EXCAVATION CERTIFICATE <br /> Project Location 5151 Almondwood, Manteca, CA 95337 <br /> Owner Tuff Boy Leasing Phone No. (209)239-1361 <br /> Contractor Jim Thorpe Oil , Inc . Phone No. (209)368-6175 License No. 495699 <br /> Owner is going to backfill the excavation. <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> _ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion. or <br /> _ 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 /> _ A. Pea gravel--smooth, rounded material not more than one-half(1/2) 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 pe=. rted for backfill if contact will be made between <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> DECLA -kTION <br /> I hereby 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 1000 gallon tank <br /> displacement and that the entire excavation will be backniled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> Martin Harris <br /> * X�X�XX�1X.XiXX}I�'zX�)F��FXX�X��£YLX <br /> ,Name ( :,nth) ` — <br /> * XIX Owner <br /> a e i nnt) <br /> =arure <br /> Shall be the responsible managing employee on the license or authorized agent. <br />