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5/16/2018 Annual Report ePermitting Signup - Google Forms <br />https://docs.google.com/forms/d/1lrxOW3YTBhUqGtqfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNgm2SDFxaO2fzUaagasEjzBzlfijfIaQ22ogLb_9kfWE <br />Fort Lupton <br />CO <br />80621 <br />(303)570-6269 <br />M-1984-013 <br />Collins <br />Matt <br />mcollins@blackfoxmining.com <br />City: * <br />State: * <br />Zip: * <br />Telephone: * <br />Permit/NOI Numbers (ie M-1987-189, P-2016-026): <br />Last Name of individual who will act as account administrator for the ePermitting account: * <br />First Name of individual who will act as account administrator for the ePermitting account: * <br />Email address of account administrator: * <br />The account administrator is responsible for providing the Division with a current email address for ePermitting correspondence. Please contact the <br />Division if an existing administrator email requires updating.