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Aua-30-04 04:23pm From-Gettler-Ryan Inc - +916631131T T-351 P.002/005 F-255 <br /> Project Location:;Zz40 /y 94CICA✓-- ZW4 <br /> Owner. de.(_ AL-o4-471r <br /> Lo4-crS Phone No: <br /> Contractor WWALI-v �e Phone No:Si,P.G/¢ x,7910 License No: <br /> INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br /> 1. Submission of Soil Engineer's Compaction Report within 30 days of project completion, or <br /> 2. Submission of verification, e_�., 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--smooth,rounded material not more than one-half(1/2)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 the <br /> 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 submittedwithin 30 days of rojeet completion, or submission of <br /> verification that the select material described above will be placed at a minunwn of five (S 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 /> Name t <br /> rn <br /> * <br /> e <br /> * Shall be the responsible managing employee on the license or authorized agent. <br /> EH 23 046 (Revised 10/16/03) Page i I <br />