2016-10-10_REVISION - M1999002

• Permit No: M1999002
• IBM Index Class Name: REVISION
• Doc Date: 10/10/2016
• Doc Name: Request For Succession Of Operator
• From: Solvay Chemicals, Inc.
• To: DRMS
• Type & Sequence: SO1
• Email Name: THM
• Email Name: GRM
• Media Type: D
• Archive: No

Jurisdiction
Street address
(Street numberand name) g
P
(City) (Stale) (ZIP/Posml Code)
(Province—(f applicable) (Country) [€
Mailing address
(leave blank if same as street address) (Street number andname or Post Office Box information)
I
(City) (State) (ZIP/Poslal Code)
i
i
(Province—if applicable) (Country)
I
1D Number
(Colorado Secretary of State ID number)
I
Entity name or true name
Form of entity
Jurisdiction
Street address
(Street number and name) P
i
(City) (State) (ZIP/Postal Code)
(Province—if applicable) (Country)
I
Mailin address
(leave blank if same as street address) (Street number and name or Post Office Box Information)
(City) (Slate) (ZIP/Postal Code)
(Province-fapplicable) (Country)
(If the follow ing statement applies,adopt the statement by marking the box and Include an attachment.)
There are more than three merging entities and the ID-number(if applicable),entity name or true
name, form of entity,jurisdiction under the law of which it is formed,and the principal address of
each additional merging entity is stated in an attachment.
2. For the surviving entity which is a foreign entity,its entity ID number(if applicable),entity name or true
name,form of entity,jurisdiction under the law of which it is formed,and principal address are
(Caution: The surviving entity cannot be an entity formed under the laws of Colorado.)
ID Number 20121690631
(Colorado Secretary of Slare ID number)
MERGE FG►Y Page 2 of 5 Rev.5/29/2007