2010-11-15_REVISION - M1980244 ‎(182)‎

• 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

•
•
COMPANY:
ADDRESS:
NAME
CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE
BASED UPON VISUAL OBSERVATION ONLY
GEOSYNTHETIC INSTALLER
Lonestar Lining Co.
4520 Half Crown Drive
Dallas, TX 75237
I, the Undersigned, the duly authorized representative
of
do hereby accept the area of Aoil surface bounded by, s `5-.13
14Y/nth 5- 9 g"y�hl
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.
• �I ' r ill( / / NA RE
NA SIGNATURE
I, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the
area of soil surface bounded by
Reviewed by:
amen"
PROJECT
LOCATION: Cresson Project
PROJECT: CC &V CQA Phase 5
OWNER: Cripple Creek and Victor Gold
Lonestar Lining Co.
E
� (0.5 7 /rte /m
TITLE DATE
Date: X11$11
A / I ;eva
DATE