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2019-11-27_REVISION - M2004009
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2019-11-27_REVISION - M2004009
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Entry Properties
Last modified
12/27/2024 2:45:48 PM
Creation date
12/2/2019 9:19:54 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2004009
IBM Index Class Name
Revision
Doc Date
11/27/2019
Doc Name
Request for Technical Revision
From
Asphalt Specialties Co.
To
DRMS
Type & Sequence
TR6
Email Name
ECS
MAC
Media Type
D
Archive
No
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ASPHALT SPECIALTIES CO. 110064 <br /> VENDOR • ..- NAME CHECK NUMBER" <br /> 0 ora o ro ec ama wn mI a e <br /> REFERENCE DATE • • <br /> 1119482 M-2004-009-202 11/ /19 Turnpike Tech Revision( f 216.0 0.0 0.0c 0.00 0.00 216.00 <br /> VENDOR NO. GROSS AMOUNT DISCOUNT RETAINAGE PREVIOUS BALANCE NET AMOUNT <br /> 10540 216.0 0.0 0.00 0.0 0.00 7216 <br /> THE KEY TO DOCUMENT SECURITY-HEAT ACTIVATED THUMB PRINT-ADDITIONAL SECURITY FEATURES INCLUDED-SEE BACK FOR DETAILS <br /> �. soo,7,h��eCO 80 Floor 110064 ' <br /> ASPHALT 10100 DALLAS ST. Der,coaozo2 so-7enu z <br /> & <br /> HENDERSON,CO 80640 BAINK�WEST ,_eoo-aee-zzss <br /> MEMBER FDIC <br /> SPECIALTIES C O. OPERATING ACCOUNT DATE CHECK NO. AMOUNT <br /> 11/22/19 110064 $216.00 <br /> ***Two hundred sixteen and xx/100 Dollars*** <br /> 3 <br /> 3 <br /> Colorado Div Of Reclamation Mining&Safety <br /> PAY 1313 Sherman St. #215 <br /> TO THE Denver CO 80203 <br /> �P<9EHg�/L <br /> ORDER r mi <br /> I OF <br /> n s <br /> _ _ - --AUTHORIZED SIGNATURE <br /> €.._........_..._.....,.....__..."...._.__......_._.. _....._.__.. u......_...,.............__,......._,..,..... .._,....,.,.-.. _.. -.-_._- <br /> II■ LL004u' 1: L2LL007821: 050S73542 <br /> 6 .1 <br />
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