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BACKFILL EXCAVATION CERTIFICATE <br /> SII <br /> ' ' <br /> project Location <br /> 2315 N. California St. Stockton CA 95204 <br /> Owner.Norman Higgins, P.O. Box 369, Clements, CA Phone 10 (209)759-3400 <br /> Norman <br /> Contractor JIM THORPE OIL INC. Phone No. (209)368-6175 License N0.495699 <br /> INDICA17E ME1110D OF BACKFILL QUALITY ASSURANCE <br /> _ 1. Submission of Sol[ 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 actingmaterial not more than one-half(12) inch in diameter . <br /> uarters <br /> ch in <br /> ross sectional <br /> B men.htremenL (Use of crushed ock w II not he per fitted material not mote than Iron backfill if contact will becmade between <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> 1 perchffyyl1 certify that a Soil Engineer's Cornpaction Report will be submitted within 30 days of�roject completion,or submission <br /> displacentelrn that <br /> that the enti1.re exec ationtbed will be backfilled ve will be and compaclaced at a ted o Insure inir compliance with thards e UniformlBuilding <br /> Code Appendix Chapter 70. <br /> * JIM THORPE OIL,INC. <br /> ame ( Hall <br /> • CONTR 'TOR <br /> =ignat <br /> Shall be the responsible managing employee on the license or authorized agent. <br /> SII <br /> i , <br /> I <br /> �,I <br />