2009-07-15_REVISION - M1980244 ‎(31)‎

• Permit No: M1980244
• IBM Index Class Name: REVISION
• Doc Date: 7/15/2009
• Doc Name: LOB Relocate- Appendix G- Subgrade Acceptance Forms
• From: CC&V
• To: DRMS
• Type & Sequence: AM9
• Media Type: D
• Archive: No

• amea&
Earth & Environmental
CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE
BASED UPON VISUAL OBSERVATION ONLY
GEOSYNTHETIC INSTALLER
COMPANY: Lonestar
ADDRESS:
PROJECT
LOCATION: Cresson Project
PROJECT: CC&V CQF? Phase 5
OWNER: Cripple Creek and Victor Gold
I, the Undersigned, the duly authorized representative
of
???1 ?t?,e•? ? ?,rJ d ; ? MFiv`?li f.
do hereby accept the area of soil surface p bounded by (NorthinglEasting)
/?
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.
ll'
NAME
-)b , c.5,
TITLE
DATE
1, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the
area of soil surface bounded by (Northing/Easting)
Reviewed by: Date:
Approved by: Date:
•
AMEC Eartk and Env&onmental