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2009-12-21_REVISION - M1980244 (36)
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2009-12-21_REVISION - M1980244 (36)
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Entry Properties
Last modified
6/15/2021 5:52:24 PM
Creation date
12/30/2009 8:52:55 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1980244
IBM Index Class Name
REVISION
Doc Date
12/21/2009
Doc Name
QA Liner Recert- App. A-G, Subgrade Acceptance Forms
From
CC&V
To
DRMS
Type & Sequence
AM9
Media Type
D
Archive
No
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CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE <br />0 <br />GEOSYNTH i IC INSTALLER <br />COMPANY: Qoh/ - . F x (�'an:;_ <br />ADDRESS: <br />. i% ,�:,e., �x - 7 5 (,S <br />PROJECT <br />LOCATION �,�� SE 7 <br />PROJECT C t ,/ ��,�/' i C lt/GIiv c cvQ��o <br />OWNER <br />I, the Undersigned, the duly authorized representative of r') F te-c <br />do hereby accept the area of soil surface bounded by 0V1 L 1 .0 ' A" <br />G - -rk <br />and shall be responsible for maintaining its integrity and suitability in accordance with the project <br />specifications from this date to the completion of the installation, <br />SIGNA <br />CERTIFICATE OF ACCEPTANCE RECEIVED SY CQA ENGINEER <br />TURE <br />LE <br />; <br />DATE <br />DA - . <br />U <br />f� <br />Reviewed by_ Date: <br />Approved by: Date: <br />He No: <br />GOL DER ASSOCIATES <br />
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