Laserfiche WebLink
JUIL -07' 00(FRII 10: 14 RB CONST,vTION IN TEL 510 68382 P. 003 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location 4 2 bl t fiRe.%" C ft--P R C-4 <br /> Owner >dt t�Mo,,1 Phone No_ u <br /> Contractor(,.k.$ 1 PhoneNo.207-932-0644. License No. <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> _ I. 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 /> A. 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 comae[will be made between <br /> the backfill material and[attics/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 sof project completion, or submission of <br /> verification that the select material described above will be placed at a m nimum of five (5) cubic yards per 1000 gallon tank <br /> displacement and that die entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> amertm� <br /> • �Re �F of DP6V_Art0-1 s <br /> (print) <br /> � bignature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />