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2010-11-15_REVISION - M1980244 (182)
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2010-11-15_REVISION - M1980244 (182)
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Last modified
6/15/2021 5:52:28 PM
Creation date
7/27/2011 12:43:14 PM
Metadata
Fields
Template:
DRMS Permit Index
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.2, PSSA Sec. Liner Subg. Accept. Forms.
From
CC&V
To
DRMS
Type & Sequence
AM9
Media Type
D
Archive
No
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• <br />• <br />• <br />CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE <br />BASED UPON VISUAL OBSERVATION ONLY <br />GEOSYNTHETIC INSTALLER PROJECT <br />COMPANY: Lonestar Lining Co. <br />ADDRESS: 4520 Half Crown Drive <br />Dallas, TX 75237 <br />I, the Undersigned, the duly authorized representative <br />of Lonestar Lining Co. <br />do hereby accept the ma of soil surface bounde y <br />Vcine.1i5 S -�f 23 <br />O R2 A lz /sir <br />NAME <br />4o, Bey <br />NAME <br />SIGNATURE <br />ame0 <br />LOCATION: Cresson Project <br />PROJECT: CC &V CQA Phase 5 <br />OWNER: Cripple Creek and Victor Gold <br />• S -ice LL/7 <br />and shall be responsible for maintaining its integrity and suitability in accordance with the <br />project specifications from this date to the completion of the installation. <br />GL� AA23-111"1-- ( /ter / Zd / c� <br />SIGNATURE TITLE DATE <br />I, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the <br />area of soil surface bounded by <br />Cap Ogb /i <br />TITLE DATE <br />Reviewed by: Date: (01 25110 <br />
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