2012-06-28_PERMIT FILE - M2012032 ‎(18)‎

• Permit No: M2012032
• IBM Index Class Name: PERMIT FILE
• Doc Date: 6/28/2012
• Doc Name: 112D‎(1)‎ APPLICATION PACKAGE, APPENDIX 3, PART 1 OF 2
• From: STAR MINE OPERATIONS
• To: DRMS
• Email Name: GRM
• Email Name: RCO
• Media Type: D
• Archive: No

Msa 1376
CHAIN OF CUSTODY RECORD
Pap _L. at L_
Relinquished by: (Pm e}
t Nam John R _ri'w llo
Sign
Chefs d Custody Tape No.:
Serial No. 25171
Relinquished by: (Print Nuns)
Signature:
Relinquished by. (print Nw-
Signature:
Date:
Time:
Date:
Tine:
Received by: (Pr ni Nally
Signature:
Date:
Time:
Date:
Time: 10 co