Laserfiche WebLink
COLORADO <br />DRMS Complaint Intake Tool Division of Reclamation, <br />Mining and Safety <br />Department of Natural Resources <br />By Submitting this form you are requesting an investigation of <br />compliance with DRMS rules. <br />COMPLAINANT INFORMATION <br />Date of Complaint <br />07/18/2018 <br />Indicates a Required Field <br />Do you wish to remain anonymous? <br />r Yes r No <br />Your First Name <br />Bill <br />Your Last Name <br />Hansen <br />Your Address <br />PO Box 1785 200 County Rd 613 <br />Your City <br />Granby <br />Your State <br />CO <br />Your Zip Code * <br />Maximum of 10 digits. (Example) 80202 <br />80446 <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 />bhansen9224@gmail.com <br />Your Phone Number* <br />Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br />970-531-3413 <br />Alternate Phone Number <br />Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br />Connection to Incident * <br />Select all that apply <br />F Land Owner r Mineral Owner <br />PF Nearby Resident r Observed Incident <br />F Other <br />DESCRIPTION OF COMPLAINT <br />