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tlEla'.f SAN JOAUUIN COUNTY <br /> 4 1''+ • �It COMMUNITY UEVELOPfdFNT OEPA111MEW <br /> won <br /> 1610 E nA2Et1O11 AVE. SIOCklon.CA 95205 <br /> OEVEI0ruEl11 Sttmm PIrH IF.120911661/70 <br /> MNAAIIO PIrA a,:12091164-.111.0 <br /> PA1.U6A1 M111E:120911663121 <br /> RUL1111xx61000 POESEINA11011 rnOnF 12091 1661021 <br /> HACRFILL EXCAVATI011 (JEII'1'IFICATH <br /> Pr.ojecL LocaLloll 1145 W. Charter Way Stockton, CA 95206 WASTE OIL TANK <br /> Owner W.W. Miles Phone flu. (415)948-6706 <br /> Conl:tacLor Jim Thorpe 011, Inc. Phone flu. 1209)368-61'15 Llcense No. 495699 <br /> 111UICATE RETHOD OF BACKFILL QUALITY ASSURAIICE <br /> 1 . Submi9910n Of Sall Enyineer's Compaction Report wltbin 30 days of project <br /> completion, or - <br /> X <br /> 7. . Submission of Veriflcatlon, e.y. load ticket, within 30 days of project <br /> completion that one of ties following materials was placed III the excavation In <br /> 12" llftal <br /> X A. Pea gravel - amooth, rounded material not more then one-half (1/2) <br /> Mich In diameter. <br /> B. Crashed rock - eel f-compactIlly material not more titan three-quartere <br /> (3/4) Inch In cross sectional measurement. (Uee of crushed rock <br /> will not be permitted for backf 111 if contact will be made between ) <br /> ties backf 111 material and Lanka/pipes made of poly reeln glass or ' <br /> similar materials. ) <br /> UECLARATIOH <br /> hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br /> it project completion, or submission of verification that the select material described above <br /> '111 be placed at a ml.nimum of five (5) cubic yards per 1000 gallon tank displacement and <br /> hat the entire excavation Will be backfilled and compacted to leisure compliance with the <br /> nlform Building Code Appendix Chapter 70. <br /> Jim 'Thorpe 011, Inc./Contractor <br /> L Richard Thorpe <br /> itame <br /> President <br /> (pr nlj <br /> L <br /> S 91 alure <br /> Shall be Lhe responsible manayllty employee on Lhe llceuse or auLllorized <br /> ayenL. <br /> Tal-Lc/necenr.00c <br />