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. F j <br /> S 'j <br /> BACKFILL EXCAVATION CERTIFICATE, <br /> Project Location Delta Sign and Crane Service," 2100 Sanguinetti LaneSt0Qktgn_ CA 952Q5 <br /> Owner Penny Patti Phone No. (209)948-1713 <br /> Contractor Jim Thorpe Oil., Inc. Phone No. (209)368-6175 License No.1 495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> I <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 ofthe following materials was <br /> placed in the excavation in 12" lifts: <br /> _�L 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 three4ma to (3/4) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfills mcontact will be made between the <br /> backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> 11 <br /> DECLARATION I <br /> -A I <br /> 1 hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of roject completion, or submission of <br /> verification that the select material described above will be placed at a minimum of five (5� cubic yards per 1000 ganon tank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> Richard Thorpe ! � <br /> ame t I <br /> Contractor l <br /> tgnantre <br /> * Shall be the responsible maaa&g employee on the license or authorized agent. <br /> 4 . <br /> 4 S <br /> I <br /> I <br /> A <br /> 1 <br />