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BACKFILL EXCAVATION CERTIFIC,& 'E <br /> ProjectLCtation 541 E. Harding Way, Stockton, CA <br /> Owner James ,King Trust Phone No.(209)951-5001 <br /> Contractor Jim Thorpe Oil , Inc. phone No.(209)368-6175 LicenseNo495699 <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.g., load ticket, within 30 days of project completion that one of the following matenals was <br /> placed in the excavation in 12" lifts: <br /> X 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 /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between the <br /> backfill 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 days 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 oallon tank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Bui'ding Code <br /> Appendix Chapter 70. <br /> Jim Thorpe Oil, Inc. <br /> x by Richard Thorpe , Vice Pres. <br /> Name (Print) <br /> x <br /> Contractor <br /> ne( ) <br /> x <br /> signature <br /> x Shall be the responsible managing employee on the license or authorized agent. <br />