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r CKFI L&CAVATION CERTIFICATE <br />Project Location Souza , 612 W. 11th St. Tracy,C. <br />Owner Souza Phone No. (209)835-8330 <br />Contractor Jim Thorpe Oil, Inc. Phone No. (209)368-617.'", License No.495Agg <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />X 2. Submission of verification, e.gload ticket, within 30 days of project completion that one of the following materials was <br />placed in the excavation in 12 lifts: <br />X A. Pea gravel --smooth, rounded material not more than one-half (112) inch in diameter <br />B. Crushed rock—self-compacting material not more than three-quarters (314) inch in cross sectional <br />measurement. (Use of crushed tock will not be permitted for backfill if contact will be made between <br />the backfin material and tanks/pipes trade of poly resin glass or similar materials.) <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 dayys of pproject completion, or submission of <br />verification that the select material described above will be placed at a minimum of five (5) cubic yards per 1000 gallon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br />Appendix Chapter 70. <br />* Richard T <br />Name (Yrmt) <br />* Contractor <br />tae nt <br />Signature <br />* Shall be the responsible managing employee on the license or authorized agent. <br />