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SEP. -21' OO (THU) 15:21 RB CCS RUCTION IN TEL:510 ..i 8782 P, 002 <br /> JUL, -0T 00 01) 10:14 RB CONSTRUCTION IN TEL-510 683 8782 P. 003 <br /> BACKFILL-EXCAVATION'CERTIFICATE <br /> Projecttncarion, 4161t. t'we.�c-tl C.�w-P V-0 eA1 TecA C4 <br /> Owner R �� Phone No. <br /> Contractor +8 FntliR.cs.�r.rl -cv�t Thane Na.71F►-y'32-oGdL Licensc No_ -L'7'�Z <br /> Iiv71ICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> I. Submission of Soil Engineer's Compaction Report within 30 days of project completion. or <br /> Submission of verification, e.g., load ticket, within 30 days of project completion that one of the followine materials was <br /> placed in the exravadon in 12- lifts: _ <br /> A. Pea gravel—smooth,rounded material not more dian one-half(1/3) inch in diameter <br /> V..'l_ Crushed rock—self-compacting material not more than three-quarters (ala) inch in cross sectional <br /> measurement. (Use of crushed rock will nor be permitted for backfill if contact will be mate 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 Enginccr's Compaction Report will be submitted widen 30of project completion, or submission of <br /> verification that rhe seleer material described above will be placed at a minimum of five (5) cubic yards per 1000 gallon tank <br /> displao ment and that the entire cxcavadon will be backfilled and compacted to insure compliance with the Uniform Bmldidg Code <br /> Appendix Chapter 70Namp. <br /> • ti � P6 <br /> * <br /> Eft-,q A- oAC pQo•, s <br /> I Inlue t,Prut <br /> Signature <br /> Sball be the responsible managing employee On the license or authorized agent. <br />