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4'06-1998 9:00AM FRI#TAIT SACRAMENTO 916 635 2606 P_ 15 <br /> • <br /> BACKFILL EXCAVATION CERTMCATE <br /> Project Locazion ©DC7 ^ F1Cf L lrY # 5 2 1 <br /> Owner `�OSCo rnARk�r/ AQfLt — �I�dotte No. �9�G� Ss i'- 7Ca� <br /> Correractor n5 C r phone No.(1071 _571 f(c�_I iearse No. <br /> LNDICATE METHOD OF BACLSF U QUALITY ASSURANCE <br /> _ 1. Submission of Soil Engineer's Cou+paetion Report withm 30 days of project completion,or <br /> 2, Submission of verificatiou,e.g., load ticket, within 30 days of project completion.that one of the following materials was <br /> placed in the excavation in 12• lefts: <br /> _ A. pea gravel–smooth, muuded material not more than One-half UM inch in diameter <br /> B. Crushed rock–self-compacting material not more tl= three (114) inch ie cross sectional <br /> em <br /> menutent. (Use of crushed tock will not be permitted for 1 if cantact will be made between the <br /> backfill material and tankslpipes made of poly ream Puss or similar materials.) <br /> DECLARATION <br /> I bereby terrify that a Soil Engineer's Compaction Report will be mbmlued within 30 days of tojeei completion,or submission of <br /> verification that the select material described above will be placed at a mmimam of 5ve (S) eubic yards per 1000 p�llon tank <br /> displacement and that the entire excavation will be bald llcd and compacted to mute compliance with the Uniform Budding Code <br /> Appendix Chapter 70. <br /> 8mena t <br /> A erlt pr- 6 vrlev i tie �t (tre=e k <br /> e <br /> �grtatnre <br /> Shall be the responsible managing employee on the license or mnhoriaed agent. <br />