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`ACKFILL EXCAVATION CERTIFICATE <br /> Project Location The right of way adjacent to 333 N. Hunter St , Stockton, CA 95202 <br /> Owner The City of Stockton Phone No(209) 937-8320 <br /> Contractor Jim Thorpe Oil , Inc. Phone No�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 /> __X A. Pea gravel--smooth, rounded material not more than one-half(1/2) inch in diameter <br /> _ B. Crushed rock—self-compacting 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 hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project 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 gallon 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 /> ame runt <br /> * COntrai2rtor <br /> itle r t <br /> * <br /> signature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />