Laserfiche WebLink
.3ACKFILL EXCAVATION <br /> �CERTIFICATE <br /> roject Location /������ fI�MM�i� ✓AN6,l <br /> Owner �,GInnMCL 1N' s � Phone No. <br /> Contractor([I"�a bjN IW�4 Phone No.sj,0 41.5365 License No. 17"63' <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion,or <br /> r 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 /> �O A. Pea gravel--smooth, rounded material not more than one-half(1/2)inch in diameter <br /> /— B measurement. (Use of crushed rock will not be permitted fnot more than or backfill if(contactt will becross <br /> made sectional <br /> between <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials. <br /> DECLARATION zy p <br /> 30 <br /> ompi <br /> verificationthat [he select material dexoribed aboveactionewoill bert lbe placcd submittedaminimum oda <br /> fi eo(5)r c)ubiccYaz se1Per l�submission <br /> gg�lon 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 /> rte rmt <br /> tgnature <br /> • Shall be the responsible managing employee on the license or authorized agent. <br />