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/'P�KF�L AVATION CERTIFICATE SW <br />Project Location <br />Souza , 612 W. 11th St. Trac CA <br />Souza 4Phone No. (209)835-8330 <br />Ownez <br />Contractor Jim Thorpe Oil, Inc. Phone No. (209)368-6175 License No.haaaaa <br />INDICATE METHOD OF BA0UML QUALITY ASSUR s"NCE <br />_ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion. or <br />% 2. Submission of verification. e.g.: load cic.'cet, within 30 days of project completion that one of the following materials was <br />plated in rhe excavation is 12' lifts: <br />% A. Pea gravel—smooth, rounded material not more than one-half (I!2) inch in diameter <br />B. Crushed rock—seif-compacring material not more Than three-quarters (3/4) inch in cross se Tonal <br />measurement. (Use of crushed roc. will act be permitted for backfill if contact will be made berneen <br />rhe barL511 material and ctnia/pipes ssdeorrrolY resin Q ass imiYarmate ials.j <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted widva 30 days of project comaletioa, oro-possubmission of <br />verification that the select material described above will be placed at a minimum of nve (5) cubic yards per 1000 gallon coax <br />disnlacement and that the entire excavation will be backfilled and compacted fo insure compliance with the Umform Building Code <br />Appendix Chanter 70. <br />* Richard T <br />—Varve �Yr= <br />Contractor <br />- Shall 6e the responsibie managing empioyee on he iicease or authorized agent. <br />