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0406,t <br />SAN JOAOUIN COUhr(COMMUNITY DEVELOPMENT bEPARTMENT <br />1610 E 1WWON AVE. SIOCKI)N. CA 95205 <br />OEVFtormEm sE11VICEs mtoNE 12091 466 J120 <br />M APIMIO PHONE: 12091 466J120 <br />1"AUNO NIONE: 12091 4663127 <br />NE1OImOmum PBESEnvmiON PIKxlE 12091 466J021 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location 446 N. Aurora St. Stockton, CA 95203 - <br />Owner. Aurora Body Works Phone No. (209)465-2636 <br />Contractor Jim Thorpe Oil Inc. Phone No. (209)462-4581 License No. 495699 <br />INDICATE NETROD OF BACKFILL QUALITY ASSURANCE <br />1. Submission of Soil Engineer's Compaction Report within 30 days of project <br />completion, or <br />_.X__ 2. Submission 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" llftee <br />X A. Pea gravel - smooth, rounded material not more than one-half (1/2) <br />Inch in diameter. <br />B. Crushed rock - self -compacting material not more than three-quarters <br />(3/4) inch in cross sectional measurement. (Use of crushed rock <br />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 <br />similar materials.) <br />DECLARATION <br />1 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 />will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and <br />that the entire excavation will be backfilled and compacted to Insure compliance with the <br />Uniform Building Code Appendix Chapter 70. <br />* Jim Thorpe Oil, Inc. <br />Name (Print) <br />Contractor <br />TX e ( rit <br />* / esident <br />ZLW <br />5lgnature <br />* Shall be the responsible managing employee on the license or authorized <br />agent. <br />6/91-LC/BECERT.DOC <br />