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
LOCATION: Cresson Project
PROJECT: CC &V CQA Phase 5
OWNER: Cripple Creek and Victor Gold
Lonestar Lining Co.
do hereby accept the area ii surface bounded by
of e ,, e,5 /7 -� 7 , 4 712
one
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, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the
area of soil surface bounded by ,
He l t/ &7/ v //o
NAME / / SIG URE TITLE DATE
Reviewed by: Date: