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OCT-24-2003 15:32 KROEKER, INC. 1 559 268 3366 P.02i08 <br /> "J) '1304 nzs:24 Lnn400 r'11 4.uu' • <br /> BACKML pxcAVATION CERTIFICATE <br /> Projcrti Locatlon: ! <br /> Owaen: �-LiU' 4" phone.No: <br /> Contractor: <br /> 1! f,;L7 �•C�. i C. phone No: t,S`�' ��:'l!' .��a/ a"_.,,1.ic=eNo: <br /> INDICATI's METHOD OF BACKFILL QUALITY ASSURANCEt completion,ar <br /> i. Submission of Soil Bogiaeer's Compaction Report within 30 days of projec <br /> Submission of verification, e.g.; load ticker, within 30 days of project compleliorr 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)itch in diaruotet <br /> B. Crushed rock—(self-coatpa0 i lz mater Lai not more than three-quarters (314) inch in cross sectional <br /> easur material and f clashed <br /> rock of not polyb espe glass oe or b similar if contact will be made between the <br /> back <br /> Uls <br /> DE(3ARATION <br /> I hereby certify that a Soil Engineers CO tion Repeat will be submitted within 30 days of rojeet comrappletion, or submission of <br /> verification that the select material desert od above 'will be placed at a minimum o£ five ( cubic yatda per 1000 ga�lan tank <br /> displacement and that the entire excavation will be backfilled and compacted to insure compliance with the Uniform Building Code <br /> Appmdnt Chapter 70. <br /> r-" <br /> at110 '.r1nt ' <br /> t <br /> * Shall be the xespomittle managing employee on the license or authorized agcot. <br /> FH 23 q)45 (Revised 3/15/02) Page 11 <br />