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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 7777 WEST ELEVENTH STREET TRACY CALIFORNIA 95376 <br /> Owner PIEDMONT LLKER g MILL CO., INC. Phone No.(510) 674 8770 <br /> Contractor JAMES J. HOBLITZELL Phone No.(209) 943 7793 License No.365234 <br /> INDICATE METHOD OF BACKFILL QUALPTy 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 <br /> was placed in the excavation to 12" lifts: <br /> XX A. Pea gravel—smooth, rounded material not more than one-half(12) 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 roject completion,or submission <br /> of 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 <br /> Code Appendix Chapter 70. <br /> JAMES J. HOBLITZELL <br /> Name (Print) <br /> CONTRACTOR <br /> Title (Print) <br /> i <br /> igna ure <br /> ' Shall be the responsible managing employee on the license or authorized agent. <br /> PAGE THIRTEEN <br />