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Aug-30-04 04:23pm From-Gettler-Ryan Inc +9166311317 T-351 P.003/005 F-255 <br /> Project Location: /✓��/,07�"PC o� .Cod b �ra c� '°"r G"'l <br /> Owner:.>N ce Qit �oo�c7T Phone No: '9/6. 4,Pe-.6l s <br /> Contractor:/92d64r'0 hoc Phone No:S/41�6���',�90 License No: 'b-� 9�9 <br /> INDICA'T'E METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion,or <br /> 2. Submission of verification, e;_, load ticket, within 30 days of project completion that one of the following materials was <br /> placed in the excavation in 12' falls: <br /> X A. Pea gravel--smooth,rounded material not more than one-half(1/2)inch in diameter <br /> _ B. Crushed rock--self-compacting material not more than three-quarters (3/4) inch W cross sectional <br /> measurement. (Use of crushed rock will 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 materials.) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project completion, or submission of <br /> verification that the select material described above will be placed at a minimum of five (5) cubic yards per 1000 gallon tank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> _Name t <br /> to t <br /> * <br /> 1 <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> EH 23 046 (Revised 10/16/03) Page 11 <br />