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BACKFILL EXCAVATION CERTIFICATE <br /> 2701 Highway 99 South, Stockton, . CA 95215 <br /> Project Location <br /> erican Transfer Company (209)466-0111 <br /> Owner Phone No. <br /> Contractor JIM THORPE OIL, INC.. Phone No. (209)368-6175 License No.495699 <br /> INDICA'T'E MET1IOD 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 <br /> was placed in the excavation to 12 lifts: <br /> A. Pea gravel--smooth, rounded material not 'more than one-half(12) 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 perchyy certify that a Soil Engineer's Compaction Report will be submitted within 30 days of roject completion,or submission <br /> of verification that the select material described above will be placed at a minimum of five(5�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 <br /> Code Appendix Chapter 70. <br /> • JIM THORPE OIL,INC. <br /> Name (Print) <br /> . CONTRACTOR <br /> tte ( nt <br /> -Signature <br /> ' Shall be the responsible managing employee on the license or authorized agent. <br />