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04/02/2001 10:31 2094683433 I p i, IR ir. <br /> PA;i 1 2 <br /> BACKFILL EXCAVA'fICIN (TY FIflf>.(1: <br /> Project Locatlon 2 0-4&Z,� <br /> { . Oumer Amo 144-IQ M,�tt i �fl _- --- I'Itouc No..-[J'�N� <br /> Contractor P.L.1/41' -&Q License No..2Q32ML__ <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> Y I. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> _ 2. . Submission of verification, e.,F ,•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(112) inch in diameter <br /> _ B. Crushed rock—self-compacting material not more than threc-quarters (314) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between the <br /> 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 days of pproject eomplet on, or sub ' sion of <br /> verification that the select material described above will be placed at a minimum of five (5) cubic yards per 1000 gall nCtan <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Buil a <br /> Appendix Chapter 70. / <br /> /dame nt <br /> A-- <br /> ffigilatuTe <br /> " Shall be the responsible.managin;employee on the license or authorized agent_ <br /> 4 <br />