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t'anlR r SAN JOAOUIN COUNT► <br /> 4 eco <br /> r i COMMUNITY DEVELOPMENT DEPAFlTMENT <br />�r u '. - - <br /> ,''�•' ' 1610 E iWELION AVE..SIOCKION.CA 95203 <br /> 1lI7 HAT DEVFLormEnI SEm4cFs PHONE 12091 4664120 <br /> ri mutN0 PHONE'1209) 466.1120 <br /> mMO1N0 PIKYIE:(2091 4661121 <br /> NE1On6Om/000 PnEWTVA11ON PHONE 12091 4663021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 900 1/2 E. Victor Rd. Lodi, CA 95240 <br /> Owner Teresi Trucking Phone No. (209)368-2472 <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 <br /> completion, or <br /> X 2. Submission of verification, e.g. load ticket, within 30 days of project <br /> completion that one of the following materials wag placed in the excavation in <br /> 12" lifter <br /> -y _ A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br /> Inch in diameter. <br /> S. Crushed rock - self-compacting material not more than three-quarters <br /> (3/4) inch in cross sectional measurement. (Use of crushed rock <br /> will not be permitted for backfill if contact will be made between <br /> Elie backfill material and tanks/pipes made of poly resin glass or <br /> similar materials. ) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br /> of project completion, or submission of verification that the select material described above <br /> will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and <br /> that the entire excavation will be backfilled and compacted to insure compliance with the <br /> Uniform Building Code Appendix Chapter 70. <br /> * Jim Thorpe Oil, Inc. dba Rich-Mart Construction <br /> Name (Print) <br /> Contractor <br /> T'it (P ' t1t <br /> * President <br /> lgnature <br /> * Shall be the responsible managing employee on the license or authorized <br /> agent. <br /> 6/91-LC/BECERT.DOC <br />