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INV .i <br />BACKFILL EXCAVATION CERTIFICATE <br />1444 N. E1 Dorado St., Stockton, CA 95202 <br />Project Location ---(209) 669-2610 <br />Multi — Day Enterprises Phone No. <br />Owner <br />Contractor JIM THORPE OILINC. Phone No. (209)368-6175 License No.495 9 <br />INUICA9I MEI'tiOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soil Englneer's Compaction Report within 30 days or project completion, or <br />2. subndsslon or 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" lifts: <br />_ A. Pea gravel --smooth, rounded gmaterial not more than one-half iInch in diameter . <br />ets <br />Inch Irl cross <br />nal <br />B Climbed meneuremenk. (Use of cru shed rock will not be permittet more I d for baonrtckfill if contact a011becmade between <br />the backfill material and tanks/pipes made or poly resin gloss or similar materials.) <br />DECLARATION <br />I belchabovecettify that a Still Enginccr's Compaction Report will be xubndtted within 3n on0 da s or i of �roject compietion, or submission <br />In <br />ofverillelentrand that ,wiccithe matire erial <br />avatloniwilt be backfilled and compaclaced at a ted) o Insure compliance cubicwith thards e Uner ifformlBuilding <br />Code Appendix Chaplet 70. <br />• JIM TNORPE OIL,INC. <br />ame ( r nq <br />• CONTi KI: <br />.' � li (Yr�l�- <br />JA 3�ignature <br />Shall be the responsible managing employee on the license or authorized agent. <br />