2016-12-13_REVISION - M1981207

• Permit No: M1981207
• IBM Index Class Name: Revision
• Doc Date: 12/13/2016
• Doc Name: Request For Succession Of Operator
• From: Western Slope Aggregates, Inc.
• To: DRmS
• Type & Sequence: SO3
• Email Name: ACY
• Email Name: GRM
• Media Type: D
• Archive: No

NOTARY FOR STRUCTME OWNER
ACKNOWLEGED BY:
Structure Owner Name
Date
STATE OF )
} ss.
COUNTY OF )
Title
The foregoing was acknowledged before me this day of , 2(L by
as of
My Commission Expires:
Notary Public