Laserfiche WebLink
RECEIVED <br />MAR 16 2015 <br />BACKFILL EXCAVATION CERTIFICATECNVIRONMENTAL <br />"CalnJMIZOA 1111CWT <br />Project <br />Contractor: <br />License No: S �i %`%',1j,i�9Z_ <br />Phone No: oz05 29e -3/x_3 <br />Phone No: -,.) o 2 3 Z.9 <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />1. Submission of Soil Engineer's Compaction Report within 30 days of project <br />completion, or <br />_ 2. Submission of verification, e.g., load ticket, within 30 days of project completion that <br />one of the following materials was placed in the excavation in 12" lifts: <br />_A. Pea gravel --smooth, rounded material not more than one-half (1/2) <br />inch in diameter <br />/ B. Crushed rock--self-compacting material not more than three-quarters <br />(3/4) inch in cross sectional measurement. (Use of crushed rock will <br />not a permitted for backfill if contact will be made between the <br />backfill material and tanks/pipes made of poly resin glass or similar <br />materials.) <br />DECLARATION <br />I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days <br />of project completion, or submission of verification that the select material described above <br />will be placed at a minimum of five (5) cubic yards per 1000 gallon tank displacement and <br />that the entire excavation will be backfilled and compacted to insure compliance with the <br />Uniform Building Code Appendix Chapter 70. <br />"Name �Girn'11&c1 ,1 4AyQv�l <br />nn / <br />Title <br />nn <br />Signature i <br />'Shall be the responsible managing employee on the license or authorized agent. <br />13 <br />