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BAC:KFII.L EXCAVATION CERTIFICATE <br /> Project Location P-7 Pa\Ilia 0s'iye- i J 'DGk GYl <br /> Owner° SOtJi',+12th Cor P®r--4-'ic:t Phone No. O 1 e,) &N-7711 <br /> Contractor f k&C c- ineei-1 s PZ*Z0kUM Phone No. N/4) 441/-9®f-f License No. <br /> �u.becrtf2ac-FcK�o e:;:s C�1�oKit,fi0r} <br /> INDICATE METHOD OF BACKFILL QUA.LPTy ASSURANCE <br /> 1. 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 ezcavatlon in 12" lifts: <br /> ✓A. Pea gravel—smooth,minded material not more than one-half(112) inch in diameter <br /> B. Crushed rock—self-compacting material not more than three-quarters (3/4) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfffl 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 ofject completion,or submission of <br /> verification that the select material described above will be placed ata ' of eve (5)ccubic 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 /> Me �tcY�lar�d �C►/�jOD��c>idh <br /> ie Ikez <br /> Nam (Friaef <br /> t> <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />