Laserfiche WebLink
BACKFILL EXCAVATION CERTIFICATE <br /> Project Location_ L 1=LL T540-L <br /> Owner_ ?Ar-tF7cc_ '(3cz_t_ PhoneNo. 516- 972- 2'101 <br /> contractor. AQ.,nVScw PW6r Phone No. '?IA -3c(-Ir. License No. S92.0tb <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineers Compaction Report within 30 days of project completion, or <br /> 1,� 2. Submission of verification, a g,, Ioad ticket,within 30 days of project completion that one of the following materials <br /> was placed in the excavation in 12" lifts: <br /> Pea gravel-smooth, rounded material not more than one-half(1/2) 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 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 days of project completion.or submission <br /> of verification that the select material described above will be placed at a minimum of five (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 <br /> Code Appendix Chapter 70. <br /> f?i6�K- <br /> ame ( nnt) <br /> y.9c ?3E L. !�6ftUdc <br /> Title not <br /> igp Lure <br /> ' Shall be the responsible managing employee on the license or authorized agent. <br />