Laserfiche WebLink
r <br /> . i <br /> 13ACKFILL EXCAVATION CERTIFICATE <br /> I <br /> Project Location 303 E_Kettleman .Lane, odi , ('A 'q�Mn f <br /> Owner Arnie .Taylor Phone No. ono* 33a_Za�2 <br /> Contractor JIM THORPE OIL, INC. Phone No. (209)368-6175 License N0.495699 . <br /> IND(CA1E ME'I'EIOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of Project:completion, of <br /> 2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials <br /> _ was placed 1w the excavation in 12" lifts: <br /> 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 <br /> the backfill material and tanks/pipes made of poly resin glass or similar,materials) _ <br /> DECLARATION <br /> I be tell ccmfry (hat a Soil Fnginecr's Compaction Report will he submitted within 30 days o(project completion,or submission <br /> of verification that the select .nateriai described above will be placed at a minimuni of five(5)cubic yards per 1000 gallon lank <br /> displacement and that the entire excavation will be backfilled and compacted to insure"compliance with the Uniform Building l <br /> Code Appendix Chapter 70. <br /> JIM T'i1ORIT, OTT IMC. <br /> Name (Print) <br /> • CONT11 �J <br /> tt { rint)- <br /> ..,nature <br /> Shall be the responsible managing employee on the license or authorized agent. f <br /> - <br /> i <br /> F <br />