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BACKFILL EXCAVATION CERTIFICATE <br /> Lockeford, CA 95237 <br /> project Location Star Buildi Sy stems 12101 E. Brandt Rd. , hone No. (209)727-5504 <br /> owner Star Buildin S stems <br /> Phone No. (209)368-6175 License No.495699 <br /> Contractor JIM THORPE OIL INC. <br /> INDICATE METFIOD OF BACKFILL QUALITY ASSURANCE <br /> _ L Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> X 2. Submission of veri0ca0on, e.p., load ticket,within 30 days of project completion that one of the following materials <br /> was placed in the excavation in 12" lifts: <br /> X A. Pea gravel--smooth, rounded gmaterial not more than one-halt (1/2) inch in diameter . <br /> inch in <br /> ross <br /> nal <br /> '— B measurement' <br /> ea.ed rock (Use of crushed mak will mit material not mote permittedhifor backfill if uarterscontact will berm de between <br /> the backliil material and tmtks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I herebyy certify that a Soil Engineer's Crnnpactian Report will be submitted within 30 day%of roject completion,or submission <br /> of verifiaafion that the select material described above will be placed at a minimum of f ve(5�cubic yards per 100i1 gallon tank <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 tint) <br /> • CON' R <br /> tt a tit <br /> tgnatur <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> I I� <br /> i� <br /> i <br /> i <br /> i <br /> i <br /> i ' <br />