2017-07-29_PERMIT FILE - M2008082

• Permit No: M2008082
• IBM Index Class Name: Permit File
• Doc Date: 7/29/2017
• Doc Name: Formal Complaint
• From: Christina Cook
• To: DRMS
• Email Name: PSH
• Email Name: ECS
• Email Name: WHE
• Media Type: D
• Archive: No

COLORADO
DRMS Complaint Intake Tool Division of Reclamation,
Mining and Safety
Department of Natural Resources
By Submitting this form you are requesting an investigation of
compliance with DRMS rules.
COMPLAINANT INFORMATION Ir
Date of Complaint
07/29/2017
Indicates a Required Field
Do you wish to remain anonymous?
r Yes r No
Your First Name
Christina
Your Last Name
Cook
Your Address
130 W. Hill Ct
Your City *
Fort Lupton
Your State
CO
Your Zip Code *
Maximum of 10 digits. (Example) 80202
80621
Email Address *
Enter a valid email address in this field to receive a confirmation e-mail and copy of your Complaint form.
[e-mail]
Your Phone Number*
Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890
303-857-0232
Alternate Phone Number
Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890
303-720-3755
Connection to Incident *
Select all that apply
W Land Owner r Mineral Owner
W Nearby Resident r Observed Incident
F Other
DESCRIPTION OF COMPLAINT