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3-01-1999 2:46PM FROM P.12 <br />BACKFILL EXCAVATION CERTIFICATE <br />Project Location HOLLY SUGAR dba SPRECKELS SUGAR <br />Owner HOLLY SUGAR Phone No. 209-835-3210 <br />Contractor N/A Phone No. N/A License No. N/A <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />_ 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br />X 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 />X A. pea gravel—smooth, rounded material not more than one-half (112) inch in diameter <br />B_ Crushed cock—self-compacting material not more than three-quarters (314) inch in cross sectional <br />measurement. (Use of crushed rock will not be pertained 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 />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 da of p�roject 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 rank <br />displacement and that the entire excavation will be backfilled and compacted to insure compliance with die Uniform Building Code <br />Appendix Chapter 70. <br />No2_rt 4n D <br />Name (Print) <br />e <br />Kw �( t <br />agnanre <br />. Shall be the responsible managing employee on the license or authorized agent. <br />MAR 01 199 14:56 PRGE.12 <br />