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Title: HDPE CQA PLAN
APPENDIX A


 
MANUFACTURER/INSTALLER COMPLIANCE AGREEMENT
 
PROJECT:
 
LOCATION:
 
OWNER:
 
GEOMEMBRANE MANUFACTURER:
 
GEOMEMBRANE INSTALLER:
 

INSTALLER REPRESENTATIVE:

 
  
_____________________ (Representative), hereby confirms that _______________ (Manufacturer's) and _______________ (Installer's) personnel have reviewd the design, specification, and quality documents listed below and in Section 1 of the project CQA Plan, and certifiy that both can, and will, comply with all design, specification, test, procedural, and quality requirements therein:
  • Design drawing numbers
  • Project Specifications - "title", date, published by
  • CQA Plan - "title", date, published by
  • Contract documents: numbers, titles, dates
Manufacturer: 
Installer:
 
Signature: 
Signature:
 
Name: 
Name:
 
Position: 
Postion:
 
Date: 
Date:
 
This document is a guide, each project's lawyer may require a custom format.

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