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LLDPE Geomembrane Liner <br />Acceptance Form <br />CLIENT: Cripple Creek & Victor Mining Co. PAGE:1 OF 6 <br />PROJECT: WEATHER:N/A <br />PROJECT NUMBER:DATE:5/26/2016 <br />Work Activity:100-mil LLDPE Geomembrane Liner <br />Area/Location:See attached Figures 1 through 5 <br />Visual inspection of installed panels <br />Visual inspection of wedge welds <br />Visual inspection of extrusion welding <br />Survey completed <br />Air testing on seams <br />Vacuum box testing on extrusion welds <br />Repairs and patches tested as required <br />3rd party conformance tests <br /> <br />Accepted: Yes X No <br />Explain:Liner accepted where Drain Cover Fill has been previously placed. <br />Signatures <br />Amec Foster <br />Wheeler ECA <br />Ames Other <br />CC&V Other <br />Items <br />Inspected: <br />Squaw Gulch VLF Phase 1 <br />74201125N0.10 <br />Tests <br />Completed: <br />Deficient <br />Items: <br />Remedial <br />Action: