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Op4U1!", C SAN JOAQUIN COUNTY <br /> COMMUNITY DEVELOPMENT DEPARTMENT <br /> 2 <br /> 1810 E.HAZELTON AVE.,STOCKTON,CA 95205 <br /> DEVELOP•.cq" a`P NPHONE:(209)468-3120 AENT RIACES PHONE:(209)488-3120 <br /> PLANNING <br /> t1FOR <br /> BUILDING PHONE:(208)488-3123 <br /> NEIGHBORHOOD PRESERVATION PHONE:(209)468-3021 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 1029 W.Fremont St. Stockton, CA 95203 <br /> owner Polar Water,Inc. Phone No. (209)466-6766 <br /> Contractor JIM THORPE OIL CO., INC. Phone No. (209)-368-6175 License No. 495699 <br /> INDICATE METHOD 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 completion <br /> that one of the following materials was placed in the excavation in 12" lifts: <br /> 3X A. Pea gravel -- Smoth, rounded material not more than one-half(1/2)inch in <br /> diameter. <br /> —B. Crushed rock -- self-compacting material not more than three-quarters (3/4) <br /> inch in cross sectional measurement. (Use of crushed rock will not be permitted <br /> for backfill if contact will be made between the backfill material and tanks/pipes <br /> made 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 days of project <br /> completion, or submission of verification that the select material described above will be placed at a minimum <br /> of five(5) cubic yards per 1000 gallon tank displacement and that the entire excavation will be backfilled and <br /> compacted to insure compliance with the Uniform Building Code Appendix Chapter 70. <br /> * RICHARD THORPE <br /> Name (Print) <br /> President <br /> Titl t) <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> 6/91-LCBECERT.DOC <br />