Laserfiche WebLink
i <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Connell Motor Truck Co. , Inc. , 2211 N. Wilson Way, <br /> Stockton, CA 9520 <br /> project Location (209)460-2411 <br /> Same as Above Phone No. <br /> Owner <br /> OJIM Ti fORPE OIL INC. Phone No. (209)368-6175- License No.495 94 <br /> Contractor <br /> INDICAXE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Slibntlssion of Sail Engineer's Compaction Report within 30 days of project completion, or <br /> X 7. Submission of veriffr�jlion, e.g,, load ticket, within 30 days of pr*cl completion that one of the following materials <br /> was placed In the excavation in 12 Ii <br /> Xinch in diameter <br /> _ A. Pea gravel--smooth, rounded material not more than one-half(1/2) <br /> Inch <br /> ross SCcli0nal <br /> B. rucis1`renieni. (Use of cpacling r ushed rack will not baterial not e permilled for backfill if ore than three-quarters contact willlbe shade between <br /> [lie s <br /> the backfill ntateriai and tanks/pipes made of poly resin glass or similar materials.} <br /> DECLARATION <br /> y gallon tank <br /> I bercl,y cerliry dial a 5�fit Engineer's Cc�mpaclic7n R �w llvble bj�ceonatia minimumtof five (S ubic yards per I(M letion or gallon t Sion <br /> of verification That the select material described above <br /> displaceiueiit and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br /> Cade Appendix Chapter 70. <br /> « JIM 'THORPE OIL,INC. <br /> ame tint <br /> • CCN'l'RA(j <br /> ui <br /> Ignature <br /> " Sliall be the responsible managing employee ort Ute license or authorized agent. <br />