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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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0 CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE <br />GEOSYNTH =TIC INSTALLER <br />COMPANY: / T.'%L <br />ADDRESS: -teT- �.: k`� ; KC-L �^ <br />, ,p , %x � -T I <br />PROJECT <br />LOCATION r�,�/� Cr <br />PROJECT 7i�/'�C- <br />OWNER CC i ✓ <br />I, the Undersigned, the duly authorized representative of POL. <br />do hereby accept the area of soil surface bounded by „�,-�! �,,� ..} %s�.,.z <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 />Jv,� fX <br />NAME SIGNATURE <br />CERTIFICATE OF ACCEPTANCE RECEIVED BY CQA ENGINEER <br />—r NAME SI NATURE <br />TITLE <br />Reviewed by: Date: <br />Approved by: Date: <br />File No: <br />6 - A3 -0 <br />DATE <br />( - ei'G <br />DATE <br />GOLDER ASSOCIATES <br />
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