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9/9/2019 Annual Report ePermitting Signup-Google Forms <br /> Annual Report ePermitting Signup <br /> QUESTIONS RESPONSES 1,Ub4 <br /> 1,064 responses <br /> SUMMARY ^"'IVIDUAL <br /> Accepting responses <br /> < 1063 of 1064 > ■ <br /> Responses cannot be edited <br /> Annual Report ePermitting Signup <br /> *DeC,.ire� <br /> 0 L 0 R A D 0 <br /> Division of Reclamation, <br /> Mining and Safety <br /> Department of Natural Resources <br /> Please complete ti,.- .w.... .. ---.- a ... .. c--,�., ,,.count for submittal of annual reports <br /> and fees. You Will receive an email with your login information Within two business days. This <br /> form is for new ePermitting account activation. If you have already enrolled in ePermitting, you <br /> Name of Permittee or N01 Holder: <br /> Tom Zimmerman <br /> Street Address: <br /> 45781 W US Highway 50 <br /> https://does.google.com/forms/d/1 lrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNgghC-RVtWLwjCHUmeDeBNsxMl7... 1/3 <br />