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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 1035 S. Aurora St. , Stockton , CA 95206 <br /> Albert Vetter Sr. Phone No. (907)697-2357 <br /> Owner <br /> Contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License N0.495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> _ L Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> X 2. Submission of verification, e.y., 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 three-quartets (3/4) inch in cross sectional <br /> measurement. (Use <br /> will not be <br /> rdcontact <br /> be made between <br /> thebackfill maal and tanks/pipesmade of poly resin or similamaterials.) <br /> DECLARATION <br /> I herch certify that a Soil Engineer's Compaction Report will be submitted within 30 da of roject completion,or submission <br /> of verification that the select material described above will be placed at a minimum of f ve(S�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 /> ame nny <br /> • CONTR <br /> to n <br /> i <br /> ig tore <br /> Shall be the responsible managing employee on the license or authorized agent. <br />