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BACKFILL EXCAVATION CERTIFICATb/ <br /> Project Location The right of way adjacent to 333 N. Hunter St , Stockton CA 95202 <br /> Owner The City of Stockton <br /> Phone No.(2O9) 937-8320 <br /> Contractor Jim Thorpe Oil, Inc. PhoneNo�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 /> — A. Pea gravel–smooth, rounded material not more than one-half(112) inch in diameter <br /> _ B. Crushed rock–selfcompacring material not more than three-quarters (314) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be trade between <br /> the backfillmaterial-and.tanks/pipes made of poly resin glass or similar marerialr.)---- <br /> X C. The tanks and excavation were filled with concrete slurry. <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 g�aal1l�on 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 /> Jim Thorpe Oil, Inc. by <br /> ■ Richard Thorpe, Pres. <br /> Name t <br /> * Conti or <br /> ignature <br /> " Shall be the responsible managing employee on the license or authorized agent. <br />