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BACKFILL EXCAVATION CERTIFICATE <br /> 12y Sova►-\ Aov,erican S+/ee-} <br /> Project Location Northeast in car-tion of Amar; can Sfreet as Washington Si- <br /> Owner ty f en Phone No. 209_937-8411 <br /> Contractor Advanrarl Cc-nRnvi rnnmAnf Phone No. 209-9560264 License No. 680227 <br /> INDICATE 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.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 /> XA. Pea gravel—smooth, rounded material not more than one-half(1/2) inch in diameter —S' ` <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 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 ofpproject completion, or submission of <br /> verification that the select material described above will be placed at a minimum of rive (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 /> * Timoth J. Cuellar <br /> ame 1) <br /> * Staff list <br /> wt 1 e t) 1 <br /> * ' <br /> Signartire AN— <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> RFFrF, V E D <br /> AUG 2 6 1997 <br /> t:NVIRONMENTAL HEALTri <br /> PERMIT / SERVICES <br />