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JR -4 96 '95 10:Z2 R.N.L. <br />u <br />nETA' Una <br />SAN JOAO4;ti :C�'NTY <br />COMMUNITY Lel"E opMENT DEPARTMENT <br />1110 CIWOO•t=:1�ON. U!4'705 <br />OMOnMa *7.,:4' r+��z 4'041 �6ea 1To <br />RNa+w3 PxD1•t :'i :7::':a <br />atAOarO YK7+E SS v <br />"OC. {Tool r61-3:21 <br />MFriM0a147S1 �'�- '-�: <br />9ACaFILL EXCAVATION CLRTIVICATE <br />project Location p}GtlG LL <br />1 <br />Phone No. Z <br />Owner G U <br />hong No. el � License No. <br />Contractor • <br />I5 TSEIROD OF BACKFILL QVAL17T AS5,J" " <br />-oiect <br />1. Submission :: 5.'`.1 Engineer's Compaction Aoport within 30 dale �-` <br />Completion, r. iroject <br />2. submissio <br />V n %'crification <br />, e.y. load ticket, within 30 dal■ <br />completion I:at zea of the !ollowing r.•aterial■ was placed is the acca`1==°n in <br />12- lifts: <br />A, Tia c_ravel - snooth, rounded material not wore than ane -half t1jQj <br />:n diameter. <br />C—shed rock - self -compacting material not n,orw than thrrz-G=artecs <br />B. 1-' ) CrUshed rock <br />,r; inch in erose sectional nasauramant. iUse of m,_e tietveen <br />• ! not be permit'. adfer backfill if contact mill bream glass or <br />iacktiil mtterial and tanksJpipes node of poly <br />materials.) <br />DECLARATION <br />t w <br />1 hereby certify that a 5011 Engineer's Compaction Reporill be submitted within 30 dove <br />of project Comylstion, or aubmies `on of verification <br />ardathat <br />rthe <br />000 gall net nk displacemo tband <br />.rill be placed at a minimum o! five (sJ v !lance with the <br />that the entire excavatio adUl chapter ba k70lled and compacted to insure comp <br />Unifox+s Building Code Apia _J <br />'" <br />Nme (rnt <br />xigure <br />a Shall be the responsible managing employes on the licence or authorized <br />agent. <br />6/91-LCIONC8AT.DOC <br />