REV03015

• Permit No: M1991097
• IBM Index Class Name: Revision
• Doc Date: 8/13/1997
• Doc Name: TRANSFER OF PERMIT & SUCCESSION OF OPERATORS APPLICATION FORM
• Type & Sequence: SO3
• Media Type: D
• Archive: No

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Permittee and Successor hereby request the State to consent to the assignment
of the Permit, to recognize Successor as Successor Operator under the Permit,
and to accept the tendered substitute Performance and Financial Warranties in
place of the Warranties presently on file with the State.
PERMITTEE
Name of Permittee
By
Signature of Officer
Title of Officer
NOTARY FOR PERMITTEE
State of )
County of

SUCCESSOR OPERATOR
~d~?AY CounrY
Name of Successor
By ~ J ~~
S' ature of Officer
t! Cvi U Ma ~0~~-
Title of Officer
The foregoing instrument was acknowledged before me this
of
as
of
Notary Public
My Commission Expires
by
NOTARY FOR//rrSU~~C,,CE~~S_~SO,,,,Rff -~
State of (iu.(,l~JL000C,(1 )
County of Q~ )
The foregoing instrument was
of ~ by

knowledged before me this ~- day
_n _.r .
of
day
~~~ ~ t ~ Notary Publ i c ~~,{,~1-~J ~ U.G/~h/
iA..1 a. ~ ~8 My Commission Expires ~a9-9~