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Name of Permittee: <br />pa. <br />Yermlt/NUl Numbers: <br />Page 4 of 4 <br />RECFIVFn <br />Agreement to Conduct Permitting by Electronic Means <br />JULg 2016 <br />DIVISION OF RECLAMATION <br />Please list all of the Permit Numbers and/or N0] numbers associated with you or your Company ETM <br />Name of Permittee: <br />pa. <br />Yermlt/NUl Numbers: <br />Page 4 of 4 <br />