OFFICE USE ONLYDATE

RECEIVEDRECEIVING

OFFICER’S NAME/SREFERENCENUMBER/S

1. Client Project information Client Name Client Project Number

2. Site address and detailsAll property details.

Street address (Include lot no., street, suburb/locality & postcode)

PostcodePlan details (Engineer, Drawing numbers & sheet numbers)

3. Scope of Work for Compliance Scope of the work covered and subject of the certification: (tick)-√ Screw piers installed in accordance with AS 2159 - 1995√ Methods used for installation comply with Heltech Site Installation Procedure Manual August 2009

Eleventh Edition√ Constructed in accordance with plans and specifications issued by Heltech.

Other (provide details e.g. scarifying etc.)

4. Installation Details Central West Screw Piers Job Number:

When was the installation started?Date

When was the installation completed?Date

5. DeclarationFull details and signature of theresponsible person will need to beprovided to verify that the work coveredcomplies with AS 2159 – 1995 andHeltech Site Installation ProcedureManual August 2009 – Eleventh Edition.

I hereby state that the work has been completed in compliance with the AS 2159 – 1995, Heltech Site InstallationProcedure Manual August 2009 - Eleventh Edition and constructed in accordance with the relevant plans andspecifications as supplied by Heltech for the works and that the information provided in this form is a true andaccurate record.

Company NameAbroearth Pty Ltd

Licence Number205643C

Phone Number Fax Number(02) 6324 5720 (02) 6324 5720

Address170 Piper Street

Bathurst Postcode 2795Date

Authoriser’s Name – Chris Bennett(Director)

Authoriser’s Signature

Certificate of ComplianceScrew Pier Installation

2August 2009 Version 4