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BACKFILL EXCAVATION CERTIFICATE <br /> ProjectUxation Lincoln Unified Schnol Dist. Maintainence Yard, 6749 Harrisburg Place, Stockton, CA <br /> Owner Lincoln Unified School District phone No. (209)953-8700 <br /> Cononclor JIM THORPE OIL, INC. Phone No. (209)368-6175 License N0.495699 <br /> INDICA'T'E MFT'IIOD OF BACKFILL QUALITY ASSURANCE <br /> L SubmisMon of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> X 2. Submission of verification, e.g., Toad ticket, within 30 days of project completion that one of the following materials <br /> was placed in the excavation In 12" Ilfls: <br /> X A. Pea gravel-smooth, rounded material not more than one-half(1/2) Inch in diameter <br /> B. Crushed rock--self compacting marerini not more than three-quarters (3/4) Inch In cross sectional <br /> measurement. (Use or crushal rock will not he permitted for backrill If contact will be made between <br /> the backfill mntelial and ranks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I bctchyy t ettify that n Soli Engineer's Compaction Report will be subnrlited within 30 da sof r )ject completion,or submission <br /> of vetificntion that the select material described above will be placed at a minimum of five (5�cublc yards per JOW gallon tank <br /> dlspincenteol and Thar the entire excavation will be backfilled and compacted to Insure compliance with the Uniform Building <br /> Code Appendix Chapter 70. <br /> • JIM THORPE DILIINC. <br /> Name r nt <br /> • CON'1'R11 " ' <br /> ie rat <br /> tguature <br /> • Shall be the responsible managing employee on the license or authorized agent. <br /> I <br /> • i <br />