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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location Lincoln Unified School Dist. Maintainence Yard, 6749 Harrisburg Place, Stockton, CA <br /> Owner Lincoln Unified School District Phone No. (209)953-8700 <br /> Contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License No.495699 <br /> INDICATE METHOD 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 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 /> X A. Pea gravel--smooth, rounded material not more than one-half(1/2) Inch in diameter <br /> B. Crushed rock--self-compactinI 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 <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I berellor (yyii acetify 111,11 a Soil Fngineer's Compaction Report will be submitted within 30 dalys of)project completion,or submission <br /> displacement rthat and that theentire ct terial excavaiontwill beed rth backfilled ve will be and compactedlaced at a minimum Insure complianceewith thards e Uniorrgitallon lank <br /> Building <br /> Code Appendix Chapter 70. <br /> • JIM THORPE OIL,INC. <br /> game not <br /> • C0N'1'RA ... <br /> tt a ntn <br /> tgnalure <br /> " Shall be the responsible managing employee on the license or authorized agent. <br />