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Connection to Incident <br /> Select all that apply <br /> r- Land Owner r Mineral Owner <br /> W Nearby Resident Observed Incident <br /> rJ Other Business owner <br /> DESCRIPTION OF COMPLAINT t.+� <br /> (Please be as specific as possible) <br /> Note: Please provide as much detail related to location and issue as possible.Without enough detail, DRMS will not be <br /> able to process or investigate the complaint and,therefore, DRMS will have no choice but to discard the complaint. <br /> Location of Concern* <br /> Please provide as much detail as possible. It is important to narrow down the location. If available, please include Township, Range <br /> and Section,physical address,or GPS location.You may also upload a pdf map below. <br /> Approx. 18700 County Road 59 Permit M1977365 Issued 4/1/1981 <br /> Incident County <br /> Park County <br /> Is this an ongoing issue(s)? <br /> r Yes f No <br /> Nature of Complaint* <br /> Select all that apply <br /> r Illegal Mining rJ Dust <br /> W Ground Water/ Water Well Impact rJ Acid or Toxic Materials/Spills <br /> W Surface Water Impact / Stormwater Management rJ Property Damage <br /> W Mine Plan Compliance rl Waste Management / Dumping <br /> Signs and Markers r] Overburden/ Development Waste <br /> Financial Warranty r] Backfilling and Grading <br /> Processing Waste/Tailings r Processing Facilities <br /> W Fish/ Wildlife rJ Erosion/ Sedimentation <br /> W Off-Site Damage W Roads <br /> r- Explosives/ Blasting f7 Topsoil <br /> W Revegetation r7 Weeds <br /> W Reclamation Plan Compliance rJ Other Impact to seasonal business as a campgro <br /> Detailed description of the issue(s)*(?) <br />