2009-12-21_REVISION - M1980244 ‎(44)‎

• 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

• CER i f FICA I E OF ACCE
GEOSYNTHETTC INSTALLEM
COMPANY'
ADDRESS: // �; J��crcFu.LL ��•.
r^Cwd A� TX - 7 SL. S
P`t ANCE OF SOIL SURFACE
PROJECT
LOCATION Z)4'',a
PROJECT i~C 1 ✓ �7,i��� F i ✓.C:� �� CCrA�Co
OWNER Cc
I, the Undersigned, the duly authorized representative of
do hereby accept the area of soil surface bounded by Ow�. s 7
and small be responsible for maintaining its integrity and suitability in accordance with the'project
specifications from this date to the completion of the installation.
NAME
TIT LE DATE
CERT1 FICATE OF ACCEPTANCE RECEIVED BY CQA ENGINEER
NAME SIGNATURE
r Q
TITLE
-/ S-e
kTE
Reviewed b ze:
• Y
Approved by. Date-
File N6:
GOLDIER.ASSOCLkTES