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BACKFILL EXCAVATION CERTIFICATE <br />Project Location Stockton Metropolitan Airport, 5000 S. Airport Way, Stockton, CA 95206 <br />Owner County of San Joaquin, Department of Aviatior�hone No. (209)468-4700 <br />Contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License No.495699 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soll 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 material not more than one-half (1/2) inch In diameter <br />B. Crushed rock--self-compacting material not more than drree-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 <br />the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br />DECLARATION <br />I hereby certify that a Sol[ Engineer's Compaction Report will be submitted within 30 days of roject completion, or submission <br />of verification that the select material described above will be placed at a minimum of five (5� cubic yards per 1000 gallon lank <br />displacement and that the entire excavation will be backfilled and compacted to Insure compliance with the Uniform Building <br />Code Appendix Chapter 70. <br />• JIM THORPE OIL,INC. <br />Name(Print) <br />s •� <br />• Shall be the responsible managing employee on the license or authorized agent. <br />