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Oct 0906 09:57a n Rsneering <br />0 <br />818847_0 <br />P.9 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location: 4 O 1� WAIN �T <br />Owner: lSL'W_A lELW IPhone No(5`St)5t33-3235 <br />Contractor:_T�21TOOJ 6a 5'i Phone NO( Fal) <br />License No: &9�60'1 <br />!NDICATE METHOD OF BACKFILL QUALITY Ac-SURANCE <br />1. Submission of Soil Engineer's Compaction Report within 30 days of project <br />completion, or <br />2. Submission of verification, e.g., load ticket, within 30 days of project completion that <br />one of the following materials was placed in the excavation in 12" lifts: <br />_A. Pea gravel --smooth, rounded material not more than one-half (1 /2) <br />inch in diameter <br />B. Crushed rock--self-compacting material not more than three-quarters <br />(314) inch in cross sectional measurement. (Use of crushed rock will <br />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 <br />materials.) <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br />ofproject completion: or submission of verification that the select material described above <br />will be placed at a minimum of five (5 cubic yards per 1000 gallon tank displacement and <br />that the entire excavation will be backfilled and compacted to insure compliance with the <br />Uniform Building Code Appendix Chapter 70. <br />A- <br />* Shall be the responsible managing employee on the license or authorized agent. <br />01 <br />