Laserfiche WebLink
BACKFILL EXCAVATION CERTIFICA' <br /> Project Location 3503 Navy Dr. , Stockton , CA 95206 <br /> Owner S.T. Services Phone No. (209)943-5662 <br /> Contractor <br /> 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 /> 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 (3/4) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between the <br /> and t kslpipes made of poly resin;lass or similar materials.) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of roject completion, or submission of <br /> verification that the select material described above will be placed at a minimum of five (o� cubic yards per 1000 ;anon 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. <br /> Name (Print) <br /> * Contractor <br /> Jim int; Inc. <br /> By * <br /> ignatur <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />