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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location <br /> 1035 S. Aurora St., Stockton , CA 95206 Albert Vetter Sr. Phone No. <br /> (907)697-2357 <br /> Owner <br /> Contractor JIM TIIORPE OIL INC. _ Phone No. (209)368-6175 License No.495699 <br /> INDICATE METTiOD 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 of verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br /> was placed in the excavation to 12" lifts: <br /> X 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 /> the backfill material and tanks/pipesUse of crushed rock will not be made of polyrresindfor glass or similarll if materintact will be als.) <br /> emade between <br /> materials.) <br /> DECLARATION <br /> 1 hereby certify 111a1 a Soil Engineer's Compaction Report will be submitted within 30 da)M, of roject completion,or submission <br /> of verification that the select material described above will he placed at a minimum of 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 /> • JIM THORPE OIL,INC. <br /> ame not <br /> • CONTR __--- <br /> tle r <br /> 1 <br /> igj ture <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> i <br /> I <br /> i <br /> I <br />