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----C-0 L--0 R A D 0 <br /> DRMS Complaint Intake Tool Division of Reclamation, <br /> Mining and Safety <br /> By Submitting this form you are requesting an investigation of <br /> compliance with DRMS rules. <br /> COMPLAINANT INFORMATION <br /> Date of Complaint <br /> li;dicates a Required Field <br /> Do you wish to remain anonymous? <br /> r r = 6, f", <br /> Your First Name <br /> Your Last Name <br /> Your Address <br /> Your City <br /> Your State <br /> Your Zip Code <br /> Email Address <br /> Your Phone Number <br /> 1}"i ,)t)C, ,,t-," <br /> Alternate Phone Number <br /> Connection to Incident <br /> d 0e,r F <br /> DESCRIPTION OF COMPLAINT <br />