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-- -- -- , ._I - - <br />12/la/0a PRI 00:31 FAX 310609630%� RBL DESIGN GROUP v RBL POTALUl1A Q012 <br />BACKFILLEXCAVATION CERTIFICATE <br />Project Location k-2 InioY ToCKTpAI <br />Owner Et�lul Wnl �nlfEQ? fusCt Phone No. "UIS- 75-1 - 199 5 <br />Contractor %l ��� �i't Com.,7<< Phone No. flat 5c99 o F2lr Licetse No. 2937'00 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />Zi. Submiaainn of Soil Engineer's Compactbn 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 tbtc following materials was <br />placed in the excavation in 12� lifts: <br />_ A. Pea gravel --smooth. rrmaded material not more than One-half W2) inch is di+memr <br />_ B. Crushed root--seif-compacting material tot molt than three-gnarrets (314) inch in class SMIOnal <br />tmeasurement. (Use of crushed rock will not be he backfill matterial and tanks pipes ttlade of Poly mmin 91239 or similar ic"sImined for backfill if s') will lx made between <br />DECLARATION <br />1 hereby certify that a Soil Engineer's Compacuon Report will be submitted within 30 da s of jeer completion, or submission of <br />verification that the Select material described above will be placed at a minimum of five (cable yards per 1000 �slion tank <br />displacement and that the enure excavunon will be backfoled and cmnpacmd m insure compliatce with the uniform Building Code <br />Appendix Chapter 70. <br />a rent <br />tgnanuc <br />• Shall be the responsible managing employee on the license or authorized agent. <br />MAP 2 4 i999 <br />