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�,et{°a`r 9AN A0 ITT COUNTY <br /> •s.i <br /> COMMUNITY DEVELOP`NT UEPAIIIMUNf <br /> v. •, 1010 E IUIF,IIUII AVE.51OCKIpl1.d1 95105 <br /> 41555$; bFvFt Ort7EIn SEnNCE9 Mlp" Ito91+aeJt20 <br /> MAIRaIp MIOIIE Ittnl IRR.3110 <br /> mA.t*kl MIOIIF�12091 4RRJ 4.1 <br /> IIEIUImOm100 rfasEnvAnO111'Ib*.12091168.301t <br /> DACKF1LL EXCAVATION CERTIFICATE <br /> Project Location 1145 W. Charter Way Stockton, CA 95206 j <br /> Owner W.W. Miles <br /> Phone No. (415)948-6706 <br /> Contractor Jim Thorpe Oil, Inc. phone No. (209)_ 368-6175 License No. 495699 <br /> IIIDICATE nBTnOO OF BACKFILL QUALITY A33URANCa <br /> 1 • lion of Soil <br /> X comcompplett ion, or Engineer's Compaction Reportwithin 30 days of project <br /> �• submissio" of ver. 1(Lcatlon, e. <br /> e0mp1etlwlbhln 30 days of roj <br /> on that one of the followinglMate Lallaid tiy was placed In he excavatpionect <br /> 12" lift"? <br /> XA. Pea gravel - "m001:11, rounded material not more than one-half (1/2') <br /> Inch In diameter. <br /> D. Crushed rock - self-compacting material not more than three-quarters <br /> (3/41 inch Ill cross sectional measurement. (Use of crushed rock <br /> will not be permitted for. back(Lll 1f contact will be made between <br /> the back(lll material and tanks/pipes made of poly resin glass or <br /> similar materials. ) <br /> DECLARATION <br /> hereby certify that a soil Engineer's Compaction Report will be submitted within 30 days <br /> If project completion, or submission of verification that the select material described above <br />'111 be pinced at a minimum of five (51 cubic yards per 1000 gallon tank displacement and <br /> hat the entlrn excavation x hr_ backfilled and compacted to Insure compliance wlth the <br /> form Building Code Appendix be <br /> 70. <br /> Jim Thorpe Oil, Inc./Contractor <br /> +? Richard Thorpe <br /> Name (print) <br /> President <br /> (Prnt) <br /> Signature <br /> Shall be the responsible managing employee on the license or authorized <br /> agent• . <br /> 91-GC/DECF.R 7.bOC <br />