Laserfiche WebLink
QiwA <br /> SAN JOAOUIN COUNTY <br /> low COMMUNITY OEVELOPA,,,,,T DEPAFITMENT <br /> IWrl/o1111VE,Slf"1a11,CA 95703 <br /> DEvElormuff StnvlcEs N""I .17091 /66 3170 <br /> MA16611(;MIa11E!17a91160 1I" <br /> aU1.11010 Motor.17n9( 166,JI71 <br /> llElol lBBlll K9o0 rnEsEmnllml Mkx*.'17091 4601071 <br /> RACRFiLt EXCAVATIOU CP.RTIFICATE <br /> Project LocaL'lor9 Valley Wholesale Drug Co. Inc. I <br /> Owner Same as above P11one No. {209)466-1851 I <br /> ColltracLor Jim Thorpe Oil, Inc. Phone No. (209)368-6175 License No. 495699 <br /> 11I01CATE "ETnou or BAcmia, (QUALITT ASSUPWICE <br /> 1 . Submission of Sall Engineer's compaction Report within 30 days of project <br /> completion, at <br /> 2• Snllml.a9l.on of verification, e..y, load ticket, within JO days or project <br /> colapletlan that one of the following materials was placed In the excavation In <br /> 12" llftef <br /> _X_ A. Pea gravel - nmooth, rounded material not more than one-half (1/2) <br /> inch in diameter. <br /> B. Cru9hed rock - Self-compncting material not more than three-quarters <br /> 11/4) inch ill 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 Lanka/pipes made of poly resin glass or <br /> similar materiels. ) <br /> DECLARATION <br /> Ilerelly certify that a Soli Engineers Compaction Report will be submitted within JO days <br /> f project completion, or submisalon of verification that the select material described above <br /> III he placed at a mtntmam of five (5) cable yards Per 1000 gallon tank displacement and <br /> hat the entire excavntion willhe backfilled and compacted to Insure compliance with the <br /> nlform Building Code Appendix chapter 70. <br /> Jim Thorpe Oil, Inc./Contractor <br /> Richard Thor e <br /> Flame (Pr nt) <br /> President <br /> (Pr nt) <br /> S1gnaEure <br /> Shall be the responsible managing employee on the license or authorized <br /> agellL. <br /> 9l-Lc/aecertr.Doc <br />