Laserfiche WebLink
t, <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location <br /> FORT OF SIOCKTON <br /> PORT OF STOCK-MN Phone No. 209-946-0246 <br /> Owner <br /> Contractor JIM THORPE OIL INC Phone No. 209-368-6175 License No. 495699 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> X 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(112) inch in diameter <br /> B. Crushed rock--self-compacting material not more than three-quarters (314) 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 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 ofproject 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 /> * BARRY H. NICE;:OLSON <br /> ame (Print) <br /> * EIWIR(7Nll'lEl NAL SPECIALIST <br /> rte t <br /> * <br /> 4�;�ignamre <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />