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v <br /> BACKFILL EXCAVATION CERTIFICATE <br /> i <br /> Project Location Reilly's Car Wash, 100 E. Lodi Ave. . Lodi, CA 95240 <br /> Owner Kevin Reilly Phone No. (209)334-r,144 <br /> Contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License No.495699 <br /> INDICATE METIIOD OF BACKFILL QUALI'T'Y ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> X 2. Sohntissinn of verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br /> was placed In the excavation is 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 he 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 beteby9 certify that a Soil Engineer's Compaction Report will he subodued within 30 da s of nro)ect completion,or submission <br /> of verification drat the select material described above will be placed at a minimum of file (5�cubic yards per 1000 gallon lank <br /> dispiacentent and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br /> Cnde Appendix Chaplet 70. <br /> • JIM THORPE OIL,INC. <br /> ame r nt <br /> • CONTRA ' ' <br /> e n <br /> signature <br /> • Sliall be the responsible managing employee on the license or authorized agent. <br /> • I <br />