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CERTIFICATE OF ACCEPTANCE OF SOIL SURFACE <br />BASED UPON VISUAL OBSERVATION ONLY <br />GEOSYNTHETIC INSTALLER PROJECT <br />COMPANY: Ames Construction, Inc LOCATION: CC & V Gold Mine <br />ADDRESS: 18450 E. 28"' Ave PROJECT: Mill Site Earthworks <br />Aurora, CO 80011 OWNER: Cripple Creek and Victor Gold <br />I, the Undersigned, the duly authorized representative of Ames Construction, Inc. do hereby accept <br />the area of soil surface bounded by <br />/' j' y �� / 1 -- 2 3 - <br />and shall be responsible for maintaining its integrity and suitability in accordance with the project <br />specifications from this date to the completion of the installation. <br />NAME SIGNATURE TITLE DA E <br />I, the Undersigned, the duly authorized representative of the CQA Engineer do hereby accept the <br />area of soil surface bounded by <br />66" Ale <br />NAME <br />SIGNATURE <br />TITLE DATE <br />