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BACKFILL EXCAVATION CERTIFICATE j <br /> Pwjcct Location 3230 N. West Lane , Stockton, CA 95204 <br /> Owner ___ Van De PO1 En erpriS S - _,Phone No. (202) Gr ,921 - <br /> Contrnclor_JIM 111ORPE OIL, INC, Phone No. (209)368-6175 License No.495699 <br /> INUICA'I'[i MF,"I'Ilot) Or RACKFILL QUALITY ASSURANCE <br /> I. Subndsslon of Soll Fnglncer's Collyncllon Report within 311 dnys of project completion, of <br /> 2. $III)IIISh111 of ver MenIloll, a RR., pond flekel, wilhln 3l)days of project completion Ilial. one of the following materials <br /> wns pinced hl Ilse excavation In U." Ilfls: <br /> A. Pen grnvel-"smoolh, rtontnicd tonterinl not more than one-half(112) Inch In diameter <br /> R. Crushed rock—self coohpn<.Ungmnterial not more than three,ganriers (3/4) Inch In cross sectional <br /> ntact will <br /> l lland lan ks/pip <br /> I1 es nlndewill h IIf pbe oly 1e5111IIglmsfor backfill If or shnlinromnlertalq.) made between <br /> lite Im Hill nmef int <br /> D F(-LA R AI I O N <br /> I hl'Ir byy„CII fy that a Boll finginrer's Coulpnction Rrporl will be sulnnpUcd within 30 days of�hro)ec(completion,or submission <br /> lon tank <br /> I)( L palll(alln to d Thal tleeentitelexeavnton .ill be-11110 lbnckfilled ve will be and comlpacledlto Insure con compliance with thards eeUnif01o1rmlBuilding <br /> Code Appendix Chaplet V. <br /> . JIM 1,110 PE OTI,tTNC. <br /> Name ZrrZm <br /> ZCONTH ;IQtio 1►e <br /> Shall he the tesponsible nlnnnging employee on the license or nuthorixed agent. <br /> i <br /> i <br /> j <br />