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�`, KFILL EXCAVATION CERTIFICATE <br />Project Location 342 N. Hunter, Stockton, CA 95202 <br />Owner St. John's Episcopal Church Phone No. (2n9 )aFF_Fgi 6 <br />Contractor Jim Thorpe Oil 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 completion, or <br />_ 2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials was <br />placed in the excavation in 12 lifts: <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 />measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between <br />the backfill material and tanks/pipes 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 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 />* Jim Thorpe Oil, Inc. by Richard Thorpe <br />Name rmt <br />* <br />Conty4ctor <br />Title <br />Sign&uref <br />* Shall be the responsible managing employee on the license or authorized agent. <br />No determination of the backfill method or material has been made <br />at this time. We are currently working with Mr. Jay Coffee of The <br />City of Stockton Building Department to decide which is the best <br />method of backfill. The end product will meet with all City regulation. <br />