Laserfiche WebLink
COLORADO <br /> M. Wilill M FIM1111 . . Division of Reclamation, <br /> Mining and Safety <br /> By Submitting this form you are requesting an investigation of Department of Natural Resources <br /> compliance with DRMS rules. <br /> DRMS Internal Information <br /> Select Permit Type <br /> Minerals <br /> Permit No List <br /> M1977365 <br /> COMPLAINT INFORMATION n <br /> Date of Complaint <br /> 05/09/2017 <br /> *Indicates a Required Field <br /> Do you wish to remain anonymous? <br /> r Yes r No <br /> Your First Name <br /> Robert T <br /> Your Last Name <br /> Robinson III <br /> Your Address <br /> PO Box 191 <br /> Your City <br /> Hartsel <br /> Your State <br /> c0 <br /> Your Zip Code <br /> Maximum of 10 digits. (Example)80202 <br /> 80449 <br /> Email Address <br /> Enter a valid email address in this field to receive a confirmation e-mail and copy of your Complaint form. <br /> rob@chaparralparkgeneralstore.com <br /> Your Phone Number* <br /> Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br /> 719-836-0308 <br /> Alternate Phone Number <br /> Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br /> 719-838-1298 <br />