2010-11-15_REVISION - M1980244 ‎(177)‎

• Permit No: M1980244
• IBM Index Class Name: REVISION
• Doc Date: 11/15/2010
• Doc Name: QA Monitoring and Test Results 2010, VOL. III, Appendix G.1, OSA Primary Liner Subgrade Acceptance
• From: CC&V
• To: DRMS
• Type & Sequence: AM9
• Media Type: D
• Archive: No

•
CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE
BASED UPON VISUAL OBSERVATION ONLY
GEOSYNTHETIC INSTALLER PROJECT
COMPANY: Lonestar Lining Co. LOCATION: Cresson Project
ADDRESS: 4520 Half Crown Drive PROJECT: CC &V CQA Phase 5
Dallas, TX 75237 OWNER: Cripple Creek and Victor Gold
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I, the Undersigned, the duly authorized representative
of
do hereby accept the area of soil surface ace bounded by
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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.
NAME SIGNATUR g aJ.24—
461 R ea
Reviewed by:
Lonestar Lining Co.
one
Date:
TITLE' DATE
I, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the
area of soil surface bounded by
NAME SI TURE TITLE DATE
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