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2010-11-15_REVISION - M1980244 (175)
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2010-11-15_REVISION - M1980244 (175)
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Last modified
6/15/2021 5:52:28 PM
Creation date
7/27/2011 12:43:22 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.3, PSSA Pri. Liner Subg. Accept. Forms.
From
CC&V
To
DRMS
Type & Sequence
AM9
Media Type
D
Archive
No
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• <br />• <br />CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE <br />BASED UPON VISUAL OBSERVATION ONLY <br />one <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 area of soil surface bounded by <br />Peme Ls --397 • 1 ?_L // <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 />2-1 al NA E <br />e H <br />NAME <br />LOCATION: Cresson Project <br />PROJECT: CC&V CQA Phase 5 <br />OWNER: Cripple Creek and Victor Gold <br />OL-a <br />SIGNATU AlTE / DATE <br />SIGNATURE <br />cCP/q <br />TITLE <br />Reviewed by: J H Date: q120/10 <br />I, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the <br />area of soil surface bounded by <br />© 7/ /a <br />DATE <br />
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