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9/26/2019 Annual Report ePermitting Signup-Google Forms <br /> 4nnual Report ePermitting <br /> QUESTIONS RESPONSES 1,073 <br /> 1,073 responses <br /> SUMMARY Accepting responses • <br /> -mob.. <br /> 1073 of 1073 ■ <br /> Responses cannot be edited <br /> Annual Report ePermitting Signup <br /> R e q Lli�",q d <br /> COLORADO <br /> Division of l atio , <br /> TIA Mining and Safety <br /> Department of Natural Rcsou-rces <br /> Please complete this form to create a new ePermitting account 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 /> should not complete thi-q form. <br /> Name of Permittee or NOI Holder: <br /> Stefan Mocevic <br /> ............................................................................................................................................................................................. <br /> Street Address: <br /> 6460 S Quebec St <br /> ............................................................. <br /> h ttp s://d o cs.g o o g I e.co m/fo rm s/d/11 rxOW3YT B h U q G tq feX D s K5 G kvVj w_j F E-9j m i KZ U R F s/e d i t#re s p o n s e=ACY D B N i n d D 111 H F m B Otq q vyo 0 g d a P S 3 B Ktsj... 1/3 <br />