2017-02-09_GENERAL DOCUMENTS - M1999007

• Permit No: M1999007
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/9/2017
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Ace West Trucking, Inc.
• To: DRMS
• Email Name: THM
• Email Name: SLB
• Media Type: D
• Archive: No

Agreement to Conduct Permitting by Electronic Means
Name of permittee representative desiring to
opt in to ePermit: h ']
Title:
5
Name of permittee:
Signature:
ePermitting Administrator(if different from
representative signing agreement)
Email Address for ePermit Account: J
nrk Act PA",
Notarized Affidavit of Sismature
STATE OF: )
COUNTY OF: \ �'
) ss.
The foregoing instrument was acknowledged
before me this day of +6Bild by
( ate) (month) (year)
as
(Name of permittee representative) (title)
of
EL
(permittee)
T "LIC
OMELL CARTENENSEN
(seal) � sto Pubft
My Commission expires: .
1. : Welk
COMMISSION 2ot9
NO
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