2018-12-18_REVISION - M1997026

• Permit No: M1997026
• IBM Index Class Name: REVISION
• Doc Date: 12/18/2018
• Doc Name Note: Incomplete
• Doc Name: Request For Succession Of Operator
• From: Oldcastle SW Group
• To: DRMS
• Type & Sequence: SO2
• Email Name: SJM
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF 5 MILE PIT AFFECTED AREA
ACKNOWLEGED BY:
Structure Owner Name
Date Title
STATE OF )
ss.
COUNTY OF )
The foregoing was acknowledged before me this day of 120 by
as of
My Commission Expires:
Notary Public