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Sent By: RHL DESIGN GROUP; 7077656835; Dec-22-98 3:59PM; Page 3/4 <br /> 12/13/88 FR1 09:34 FAX 5106086304 RUL DESIGN GROUP ++ L PETALUMA (1012 <br /> BACKFILL EXCAVATTON CERTIFICATE <br /> project Location— 1+40 1iU.� C►nar�er 1/�n+Y ��ToUt T�n� <br /> Owner a %Lori Phone No. 'US- 757- M9 5 <br /> Contractor Phone No. Ss <br /> c - y-y o`fZ�Litxme No. 9� 76 D <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> */I. Submission of Soil Engineer's Compoctian Report within 30 days o4 project cozopLDtian.or <br /> 2. Submission of verification, a-Jload ticket, within 30 days of project compiethm that one of the MHOWing tMteriala was <br /> placed in the ezczvation in 12 lifts: <br /> A. Pea gravel-smooth, roroaded metrial not more than Gm4ulf(I!2) inch in diansom <br /> _L B. Crushed rock-sdf-catnpactia8 matntist not =re than three-gums (314) inch in cross sectional <br /> moasuremcnt. (Use of crushed rock will not be permitno i for bickffl if coaunct will be made between <br /> the backfill material and tanks/pipes trade of poly ream gl <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of lett compled0n, or submission of <br /> vardiieatton that the select material desertlmd above will be placed at a mirutnum of five ( cubic ya:ae per 1000 gi`Il00 talc <br /> displacement and that the entire excavation will be backfilled and compacted w unsure compiiance with the Uniform Building Code <br /> Appendix Chapter 70. <br /> ame Prbwrr <br /> Cv« /rte (f -t'J <br /> rgnattu'e <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> xa <br /> MAR 2 4 1999 <br /> PERMIT/SERVICES <br />