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BACKFILL EXCAVATION CERTIFICATE <br /> Project Location: 3 East Eleventh Street, Tracy, CA <br /> Owner <br /> Louis Levand Trust, Et. al. Phone No: (661) 904-2133 <br /> Contractor: Advanced GeoEnvironmental, Inc. Phone No: (209)467-1006 <br /> License No: 660227 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project <br /> completion, or <br /> x 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 /> x 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 /> wl (pproject completion, or submission o))f verification that the select material depplacement and <br /> scribed above <br /> llon tan <br /> thatbthe laced at a minimum entie excavation will fbe bfiveackf II dcub�cad yards ompactted ter 1000 onin insure comik pliance with the <br /> Uniform Building Code Appendix Chapter 70. <br /> *Name <br /> nn <br /> Title <br /> (Print) <br /> Signature <br /> *Shall be the responsible managing employee on the license or authorized agent. <br />