Laserfiche WebLink
BA'KFILL EXCAVATION CERTIFICATE <br /> Project Location {2t�1 t fiYZP qua CSP Q D 'M 'cet+� CA <br /> Owner Phone No. r� <br /> Contractor �y.'g Fn�ti��+�an'c'h <br /> Phone No--2&?-432-OGdL License No. 7,W757,7_ <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 /> _ 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 /> permitted for backf <br /> the backftllnmaterial and tanks/pipUse of crushed es trade of pk will not oly resin glass or siimilarlmateriif contact will be made between <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project completion, or submission of <br /> 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 Code <br /> Appendix Chapter 70. <br /> * <br /> Name rmt <br /> * <br /> tt a rmt <br /> * <br /> Signature <br /> * Shall be the responsible managing employee on the license or authorized agent. <br />