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BACKFILL EXCAVATION CERTIFICATE <br /> project Location Panella Trucking, Inc. , 5000 E. Fremont St. , Stockton, CA 95215 <br /> Owner Panella Tnuckina Inc _Phone No. (2nO)QLa5aQc - - <br /> contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License N0.495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> X_ L submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br /> was placed In the excavation In 12" lilts: <br /> 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-quarters (3/4) Inch in cross sectional <br /> theabackfillnt. (Use of cruserockmaterial and tanks/pipeswmaderof polyill nt be rresindfor glassbbe made between <br /> or similar materials.) <br /> DECLARATION <br /> I hereby certify thni a Soil Engineer's Compaction Report will be submitted within 30 days of roject completion,or submission <br /> of verification that the select mnrerinl described above will be placed at a minimum of five(3�cublc 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 /> Panella Trucking, Inc. , by Art Pratt <br /> Name (Print) <br /> Manager <br /> --T t e (Print) <br /> Signature <br /> • Shall be the responsible managing employee on the license or authorized agent. <br />