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04/29/2003 15:18 2094671118 AGE STOCKTON PAGE 02 <br /> YML.LJCLJ crw i tvtr vL. zMi4b4�bbb 04 -1/03 04 t 21p�n P. to1 <br /> C4/29/2803 15-11 2044671 i 1 AGE STOC:ICFUN 01/01 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project f_ocation—J110C1 / , C,4 <br /> bwarcr n+e/` Co . Phone No. <br /> _A2J — T�2- y�d <br /> Gt3rtrraeter Ua�u �r1 'n of r;rL Phone No. ?. e-'sevo. o <br /> INDICATE MUMOD Or-aA.CKFU.L,QVALITY ASSURANCE <br /> J. Sulatnission of SoU Eaginecr's Compactioa Report witWn 34 days of projeat completion,or <br /> I S6misxlon of vcriftcation,&.g.4 load ticket. within 30 days of project Coatpledon that one off the Following materials WAS <br /> placed In Me excavation iA 12 lifts; <br /> .X.A- Pea gravel--sMooth, rounded maierial not.mor,-than one-half(111)imla in dlamcwr <br /> R,, Crushed rtaclC--seat-epmg}3Ctln material not more khan tbrcc-quttartbra (314) inch in ernes rartivnal <br /> me2sureFW1. ((Ilse of crush. ItOck will bot he yetrnitted for bacltfdl if contact will be made btrween the <br /> backfill material and tsnk!0pipes trade of poly retia glass or slmilar rnxrer;atm-) <br /> DECLARA`T'ION <br /> ]berrby cenify ilial a Soil Iwstgineer'e Compactton Report will be submitted uwitWn M day 8 at peojeer comple•tlnu.or sub n�siw of <br /> verifleadon that the stimt.Material dwzo6bcd above wtll be Placed at a minimum of tr+k (5) cubic yards gt:r 1000Jw lull tank <br /> cbsplatcmrnt and that the emirs cxtavation will be backAl(ed and completed to i"'Wrc compliance.vldt the V:hifmm Blinding Code <br /> App nWx Chapter 70. <br /> erne rrnt <br /> at c <br /> tore <br /> ' Shall be the rwptMsible managing vmployee co the liccnat or authorized agent. <br />