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i <br /> SACK'rILL EXCAVATION CBRT:FICATE <br /> i <br /> Project Locatica North Stockton Auto Serviice , 8702-'N,-Davi c; Rd �,, R#ncktr= CA <br /> Owner Ed Niemann P11= No. (209)478-1614 <br /> Contractor Jim Thorpe Oil , Inc"PhQrx Na.(209)368-6175 License No.4956gg <br /> INDICATE METHOD OF BACKr ILL Qi3ALiTY:ASSURbNCE <br /> 1. Submission of Soil Engineer's Compaction Repot:w;thin 30 days cf project cz;mpletion, or <br /> X 2 Submissicn of verifiauion, e.g.,, load :ickr, within �0'days of project comp:zdon that one of the feilovin; materials WE-3 <br /> placedit the ezzavadon in 12"lifts: <br /> X A, Pea gt1`,e1—sraooLh, rounded material not more than one-half;112) inch in diameter <br /> B. Crushed rock--self-compacting material not mete than hreo cluartcrs'(3.4) inch in cr,:ss sectional <br /> a easysezaert, ([Jre of en:sbed ruck u.11 not be permitted for for-backfill i. contact will be rsade berveen <br /> the backfill material and maksipipes made of Wily resin glass or similar materials.; <br /> D ECLARA710N <br /> I horeby cerdlfy that a Soil Bn;ineer's Compacdor Repon will be subn-ittez wi.hin 30 dZyS of project co tpletion, oY 5ubmissior.or' � <br /> verification that the select material desc:�bcd abase will be placed at a m.nirCiltn of ;tvc (5) cubic yards per IDOO gzllon task <br /> displacement and that the entire excazvancn Will be basic gilled ar:d ccrnPactcd to insure earagliarce with the Uniform Sul€ting Code � <br /> .kppendit Chapter 70, <br /> Jim Thorpe„ 0i1 , Inc. <br /> .4 by `Richard- Thorpe , Pres. <br /> Name <br /> o Contractor <br /> 17. I tint <br /> .gstatur= �� <br /> i <br /> P <br /> } Shall be th-e responsible manz;ing etrployee or.the 1:cense or authorize~aaeM <br /> i <br /> `r <br />