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�� iu 1 JJJ r,7•rJVX-�'i i i U�i I U 14LJL51ti(tjL H. 1e <br /> � -EXCAVATION CERTIFICATE <br /> Project I,ocatfo li` e.- <br /> Owtt�r_ /EU Phanc No. <br /> Contractor. Phone No. <br /> �- D License No. <br /> INDICATE METHOD OF BACICHU QUALITY ASSURANCE <br /> /1 Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> Submi Ilion of yeriEcatioa, e.g.. load tir.Y.et, within 30 days of <br /> placed ih the ezcavaoon in 12' lifts: Pini comPletion that one of die following materials was <br /> '=. A..:Pea gravel—lawOth, rounded martriai tsoc more than one-half(1/2) inch in diameter <br /> B: :Crushed rock self-co�c dng material = more than <br /> � - (Use of crushed rock will not be i f3�ut inch in cross sectional <br /> �e backfill rt hal tanks/pipes permttzed for backfill if contact WM be made between <br /> pipes made of poly resin glass or similar mamriais.) <br /> DECLARATION <br /> hereby certify a Soil Enginecr's Compaction Repots will be submitted within 30 clays of roject compiction, or submission of <br /> erifieation that sel=l maaterial described above will be placed at a mi�num of five (5� cubic yards per 1000 gallon tanl <br /> isplacealeut d at tihe tntire excavation will be backfMe;d and compacted to irlstiro compliance <br /> .ppendix Chap 70. mptiatice with the Unif rm Building Code <br /> amc <br /> C <br /> hgnature <br /> Shall be the ble mannging employee on the license or authorized agent. <br /> I <br /> I� <br /> I <br /> l <br /> I <br /> i <br /> j <br />