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2013-08-28_REVISION - M1977306
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2013-08-28_REVISION - M1977306
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Entry Properties
Last modified
6/15/2021 2:28:40 PM
Creation date
9/11/2013 7:16:24 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1977306
IBM Index Class Name
REVISION
Doc Date
8/28/2013
Doc Name
Notarized Consent Agenda Summary Form
From
Cotter
To
DRMS
Type & Sequence
AM1
Email Name
THM
GRM
Media Type
D
Archive
No
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Operator(s) Signature: <br />By signing this, the Operator agrees with the request to extend the review period beyond the 365 <br />days to January 8, 2014, as outlined above on the Staff Summary Form for Consent Agenda <br />Items. <br />A <br />Z�7/ / <br />6pb�erator Signature Date <br />STATE OF_QptDYQG�D } <br />COUNTY OF__ a&Q 1OX } <br />The forgoing instrument was hereby acknowledged before me this (7 day of , <br />by 6kh ylh 14' 1W , who is personally known to me or has provided <br />Nor" bt-iytr5 betn.st, as identification, and who signed this instrument willingly. <br />(jai" t'6 <br />Notary Public <br />ission expires: . lW5– —__ <br />T <br />
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