Laserfiche WebLink
12/18/98 FRI 09:34 FAX 5106096304 RHL DESIGN GROUP RHL PETALUMA Z012 <br /> BACKFILL EXCAVATION CERTIFICATE <br /> Project Location^ 4�� . ckay42x SToUV_T0nJ <br /> Owner IE!a; _A l Lc nl Phone No._ �s- 75-7— l9 9 S <br /> Contractor f-- ,- T 1Phone No.2,y _371 4 License No.2</3 ,7 <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> V'1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 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 /> A. Pea gravel--smooch, rounded material not more than one-half(112) inch in diameter <br /> -� B. Crushed rock—self-compacting material not more than three-quarters (3/4) inch in cross sectional <br /> measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between <br /> the backfill material and tanks/pipes made of poly resin glass or similar materials.) <br /> DECLARATION <br /> I hereby certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project completion, or submission of <br /> verification that the select material described above will be placed at a minimum of five (5) cubic yards per 1000 gallon 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 /> crne (P <br /> 1 <br /> / A_/ <br /> T/•1Lle <br /> Signature- <br /> Shall be the responsible managing employee on the license or authorized agent. <br />