Laserfiche WebLink
oat 09' 06 09: 57a n R F*neering 818842 P. 9 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location: 4:70 1J VlCAIN zT <br /> Owner. UL'CV-A 4EI A1? It�(S Phone NoL!50 t) 583-3235 <br /> Contractor: T\21 WI-4 (ISS'! Phone No( F,6 1) <br /> License No: <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineers 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 /> (3/4) 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 /> of project completion, or submission of verification that the select material described above <br /> will be placed at a minimum of five (5cubic 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 /> .So�.N. M•�lAq <br /> �1 <br /> -Name n <br /> .iekf <br /> — Sign�ure <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> �t <br />