2010-11-15_REVISION - M1980244 ‎(175)‎

• 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.3, PSSA Pri. Liner Subg. Accept. Forms.
• 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.
ADDRESS: 4520 Half Crown Drive
Dallas, TX 75237
I, the Undersigned, the duly authorized representative
of
do hereby accept the area s ce it su a bounded by
o o ne,(,a'- 3 6i
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.
•
NA SIGNAT RE T1 LE / DATE
1, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the
area of soil surface bounded by
�h ea
NAME
SIG
LOCATION: Cresson Project
PROJECT: CC &V CQA Phase 5
OWNER: Cripple Creek and Victor Gold
Lonestar Lining Co.
• 7
ATURE TITLE
amee
Reviewed by: St' Date: 91 1 2 j tO
DATE