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C <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location 3032 E. Waterloo Rd., Stockton, CA 95205 <br />Owner Gurpal Sidhu Phone No. 209-466-5816 <br />Contractor Oil Eaiiipmpnt Sere, ge Phone No. 2Q2-754—_1_808 License No. 323417 <br />INDICATE METHOD OF BACKFILL QUALITY 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 In 12" lifts: <br />X 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 project 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 />*Keith A. Tallia <br />name (Ynnt) <br />* A ent <br />It a Il t <br />i <br />1 t <br />* Shall be the responsible managing employee on the license or authorized agent. <br />