2022-04-11_REVISION - M2014070

• Permit No: M2014070
• IBM Index Class Name: Revision
• Doc Date: 4/11/2022
• Doc Name Note: No Fee enclosed
• Doc Name: Request For Succession Of Operator
• From: Green Acres Recycling, LLC
• To: DRMS
• Type & Sequence: SO2
• Email Name: ECS
• Email Name: MAC
• Email Name: SMS
• Media Type: D
• Archive: No

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NOTARY FOR STRUCTURE OWNER WITHING 200 FEET OF
REVENUE MINE AFFECTED AREA
� ACKNOWLEDGED BY:
�
; Applicant: Representative Name:
Date: Title:
STATE OF )
) ss.
COUNTY OF )
The foregoing was acknowledged before me this day of ,2022 by
as of
My commission expires:
Witness my hand and official seal.
Notary Public
3
U8/22:1t.a Adj Prop Owner CO