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BACKFILL EXCAVATION CERTIFICATE <br />Project Location 301 W. KETTLEMAN LANE, LODI <br />Owner CHEVRON PRODUCTS COMPANY <br />Contractor MUSCO EXCAVATORS, INC. Phone No <br />Phone No. (925)842-9083 <br />( 707) 579-0250 License No. 634117 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />X 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials was <br />placed in the excavation in 12" lifts: <br />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 be permitted for backfill if contact will be made between the <br />backfill material and tanks/pipes made of poly resin glass or similar materials.) <br />X C. STRUCTURAL BACKFILL - PLACED AND COMPACTED IN LIFTS WITH <br />VIBRATORY EQUIPMENT. <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 dais of project completion, or submission of <br />verification that the select material described above will be placed at a minimum of tive (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 Code <br />Appendix Chapter 70. <br />* BRYAN H. MUSCO <br />Name (Print) <br />* PRESIDENT <br />it e (Print) <br />gtr - <br />,d.n _,7 <br />V 1;k4 <br />rint)/;ifi' <br />Signature <br />* Shall be the responsible managing employee on the license or authorized agent. <br />