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BACKFILL EXCAVATION CERTIFICA" <br />Project Location 428 E. Fremont St., Stockton, CA 95202 <br />Owner Thp City of 3torkton Phone No. (9na)937-8358 <br />Contractor Jim Thorpe Oil, Inc. Phone No. (209)368-6175 License No. 495699 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. 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 was <br />placed in the excavation in 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 />measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between the <br />backfill material and tanks/pipes made of poly resinglass or similar materials.) <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of pproject 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 backfilled and compacted to insure compliance with the Uniform Building Code <br />Appendix Chapter 70. <br />* Martin Thorpe <br />Name (ermt) -- <br />* <br />Contractgr <br />e t <br />Signature <br />* Shall be the responsible managing employee on the license or authorized agent. <br />