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CKFILL XCAVATION CERTIFICATE <br /> - �. L .. a <br /> Souza <br /> Project Location 612 W. 11th St . Trac CA <br /> Owner Souza 'Phone No. (209)835-8330 <br /> Jim Thor ,R <br /> Contractor pe Oil , enc. Phone No. {209)36$-612,5 License No.4 r)r-Cc�c. <br /> i <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE K <br /> f <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 materials 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 (314) 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 /> .k <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 Ave (S) 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 /> * Richard Thn-rnp <br /> Name TPrmQ <br /> i <br /> * Contractor <br /> it e {Rpt <br /> signature <br /> f <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> 4 <br /> i k <br /> t <br /> i <br /> 1 <br />