Laserfiche WebLink
BAcxFu-L EXCAVATION CERTIFICATE <br /> jest Location _ L R L U <br /> `� <br /> ner — Phone No. <br /> xtractor � Se)�l C c Phone No - 43 License No. 2 <br /> INDICATE METHOD OF BAC FM.L QUALITY ASSURANCE <br /> L Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />_,,Z. Submission of�ver� , e�, load ticket,within 30 days of project completion that one of the following materials <br /> was placed to <br /> A. Pea gravel—smooth, rounded material not more than one-half(12) inch in diameter <br /> B. Crushed rock—self-compacting material not more than three-quarters (314) 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 /> or <br /> on <br /> ere5v certify that a Soil Engineer's aterial desrnbed ort wi <br /> abovction e will be placed at submitted <br /> o five (5�within 30 days of project <br /> c yardsper completion.000 gallon tank <br /> vertncation that the select <br /> placement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building <br /> de Appendix Chapter 70. <br /> C t <br /> • Name rind <br /> lide ( tint <br /> Signature <br /> Shall be the responsible managing employee on the license or authorized agenL <br />