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SAN JOA©UIN COUHt- .- .r <br /> COMMUNITY DEVELOPMENT DEPA11t•MENT <br /> T 1510 t 1UlZRIC01 AVE,51OCKIOR CA 95205 <br /> OEVE O!"Efff SEnVECf9 111011F_•12091 160.3120 <br /> PlAFROIC 1110f,E:12091 4611-3070 <br /> f"1111KI f'I1(k1t:12091 460 312.1 <br /> 11-0 90811©00 PnESEnvA110Fl P1 101*--12091 460-3021 <br /> BACKFILL EXCAVATION CERTIFICATU <br /> Project Loca Llorl Grand Auto Store 240 N. California St. Stockton, CA 95202 <br /> Owner Ray Farmer i'11v1Ie 110. (209)952-3260 1 <br /> Corftr:actor Jim Thorpe Oil, Inc. 1,11or1e No. (209)368-6175 Llcerlse No. +95699 <br /> 111DICATE HETROD OF r1ACKFILL QUALITY ASSURAIICH <br /> 1 . Submission of Soil Engineer's Compaction Report within 30 days of project <br /> comptntion, or <br /> 2. Submisslon of verification, e.g. load ticket, within 30 days of project <br /> completion that one of the following materials was placed In the excavation In <br /> 12" luta: <br /> X A. Pea gravel - smooth, rounded material not more than one--half 112) <br /> inch In diameter. <br /> B. Crushed sock - sell-compacting material not more than three-quarters <br /> (3/ 1) inch In cross sectional measurement. (Use of crushed rock <br /> will not be permitted for backfill if contact will be made between 1 <br /> the backfill material and tanks/pipes made of poly resin glass or <br /> similar materials. ) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br /> of project_ completion, or submission of verification that the select material described above <br /> w1.11 be pl.nced at a minimum or flee (5) cubic yards per 1000 gallon tank displacement and <br /> that the enttre excavntlon will he backfilled and compacted to insure compliance with the <br /> Uniform Building Code Appendix chapter 70. <br /> Jim Thorpe Oil, Inc./Contractor <br /> A Richard •rhor e <br /> Vame (Pr r1t) <br /> President <br /> AS M(print) <br /> iglia L4Ur <br /> t Shall be Lhe responsible maliagirfy employee on the license or authorized <br /> agent. <br /> /41-LC/BECERT.D0C <br />