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IIACKFiLL EXCAVATION CERTIFICATE <br /> Projecllocaton 3230 N. West Lane,Stockton, CA 95204 j <br /> OwnerVan De Pol Enterprises phone No.S2()9�)4FF_rog1 - <br /> Ctmltactor JIM Von OIL, INC. Phone No. (209)36£3-6175 License No.495699 <br /> INDICATE' ME-11101) OF BACKFiLL DUALITY ASSURANCE <br /> I. 5nhrnission of Soil Engineer's Compaction Report within 30 days of Project completion, or <br /> 7.. Subnhissfon of verification, e.g., loan fickel, within 30 days of project completion that one of the following materials <br /> wns placed In the excavalion in 12" lifts: <br /> -,-�Jr A. Pea grnvel--smooth, rormded material nor more than one-half(112) inch In diameter <br /> n. Crnshed rack--self compnrcting material not more than three-quarters (3/4) inch In cross sectional <br /> measnrernerit. (I)sc of crnsived rack will not be permitted far backfill If contact will be made between <br /> the hnckiiii nrnterlal ami links/pipes made of poly resin glass or similnr materials.) <br /> DECLARATION <br /> hr•rchyy cr;Iffy Il1at a Srlil r:ngincer's Compaction iteport will he subnriUed within 3i)da sof roject completion,or submission <br /> r( vcrIfl m on Ilial the select ntnlerinl described above will lie placed at a nrininunm of five (5 cuble yards per 100iI gallon lank <br /> Ilspi;Icenienl and Ili-it the entire excavation will be bnckfiiled and compacted it)insure compliance with the Uniform Building <br /> aide Appendix Chapter 70. <br /> • JIM TiIORIT OTI,,TNC. <br /> Name'(Fr nt <br /> • WN1'Ii ii <br /> IfcC fit <br /> R . <br /> SiRnsh ire <br /> Shall he file responsible managing employee nn the license or autirorized agent. <br /> i <br /> ' I <br /> 1 � <br /> i <br /> r <br /> t <br /> 3 <br /> s <br />