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2017-01-30_GENERAL DOCUMENTS - M1977168
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2017-01-30_GENERAL DOCUMENTS - M1977168
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Entry Properties
Last modified
12/14/2020 11:18:59 AM
Creation date
2/3/2017 3:32:09 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1977168
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
1/30/2017
Doc Name
Agreement to Conduct Permitting by Electronic Means
From
Bill Tezak
To
DRMS
Email Name
TC1
SLB
Media Type
D
Archive
No
Tags
DRMS Re-OCR
Description:
Signifies Re-OCR Process Performed
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� Agreement to Conduct Permitting by Electronic Means RECEIVED <br /> BAN 3 0 2017 <br /> ONI ION OF MINING RECL4MATION <br /> Name of permittee representative desiring to &SAFETy <br /> opt in to ePermit: Bill Tezak <br /> Title: President <br /> Name of permittee: Colorado Quarries, Inc <br /> Signature: <br /> ePermitting Administrator(if different from <br /> representative signing agreement) <br /> Email Address for ePermit Account: nkrauth@qwestoffice.net <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> CO <br /> COUNTY OF: ) ss. <br /> Fremont <br /> The foregoing instrument was acknowledged <br /> before me this 24 day of January 2017 by <br /> (date) (month) (year) <br /> as <br /> Bill Tezak President <br /> (Name of permittee representative) (title) <br /> of <br /> Colorado Quarries Inc <br /> (permittee) <br /> NICOLE KRAUTFi _ <br /> NOTARY WBUC <br /> STATE OF COLORADO <br /> NOTARY ID 199W15322 N TARY P LIC <br /> MY COMMISSION EXPIRES OCTOBER 6,2020 <br /> (seal) <br /> My Commission expires: <br /> (o C): <br /> Page 3 of 6 <br />
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