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CKFILL EXCAVATION CERTIFICATE <br /> Project Location 103 North E Street <br /> Owner A. Teichert & Son, Inc. Phone No. 916-386-6916 <br /> Contractor Triangle Inc . Of Sac . Phone No. 916-421-1990 License No. 183550 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> _ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 2. Submission of verification, e.�., load ticket, within 30 days of project completion that one of the following materials was <br /> placed in 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 hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 das of project completion, or submission of <br /> 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 Code <br /> Appendix Chapter 70. <br /> ame not <br /> . PIZ7 I e c7—' ee� <br /> ite' rent <br /> * 2� � <br /> Sigaamre <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> Teichert will backfill excavation using fill soil from open field. <br /> Soil will be compacted to our satisfaction for the intended use. <br />