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B) ILL EXCAVATION CERTIFICATE <br /> Project Location LJ 4/2tr / cif CA <br /> Owner STEGt/ Phone NoAeg) &..W--z4rx <br /> Contractor c-,'o, Phone N . 4'loG—S License No. 3& 8 <br /> L <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> L1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 2. Submission of verification, e.g., load ticket, within 30 days of project completion that one of the following materials was <br /> placed in the excavation in 12 lifts: „ <br /> A. Pea gravel--smooth, rounded material not more than one-half(112) 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 /> r <br /> DECLARATION. <br /> "hereby certify that,a Soil Engineer's Compaction Report will be submitted within 30 days of project completion, or submission of <br /> he 3 <br /> erification that tselect material described above will be placed at a minimum of five (5) cubic yards per 1000 gall'o' n tank <br /> �splacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> Name (Print) <br /> u e (Print) <br /> ignature <br /> "' Shall be the responsible managing employee on the license or authorized agent. <br />