2004-10-18_REVISION - M1980244 ‎(23)‎

• Permit No: M1980244
• IBM Index Class Name: Revision
• Doc Date: 10/18/2004
• Doc Name: Ph. IVc VOL.II Subgrade Accept. Forms
• From: Golder Associates Inc.
• To: DMG
• Type & Sequence: AM8
• Media Type: D
• Archive: No

• CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE
GEOSYNTHETICINSTALLER PROJECT
COMPANY: ~OL~/-,^/FX Co~'~'~ lnt LOCATION ,~fjy~E -~
ADDRESS: aQe~ y, r^nc_ryhc.d.( Or. PROJECT `~ J y ~nl1A.IE ~,~~%n'£ir CQA~(p
f.-~~d pfa.r.~, T,~ -75Z7sI OWNER / CC'
I, the Undersigned, the duly authorized representative of ~ (X ~~~
i
do hereby accept the area of soil surface bounded by 3 c~a v 6 ,i
G-aFS~ _
and shall be responsible for maintaining its integrity and suitability in accordance with the project
specifications from this date to the completion of the installation.
•
•

TITLE
Reviewed by:~~te: !o-f~-oT
Approved by:
File No:
Date:
GOLDER ASSOCIATES
CERTIFICATE OF ACCEPTANCE RECEIVED BY CQA ENGINEER