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10/15/2019 Annual Report ePermitting Signup-Google Forms <br /> 4nnual Report ePermitting Signup <br /> QUESTIONS RESPONSES 1,077 <br /> 1,077 responses <br /> SUMMARY Accepting responses • <br /> -mob.. <br /> 1077 of 1077 ■ <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 /> Jay Baker/Mule Creek Gravel LLC <br /> ................................................................ ........................................................................................... <br /> Street Address: * <br /> 1000 South West Street <br /> ........................................ I............................... <br /> https://docs.google.com/forms/d/l lrxOW3YTBhUqGtqfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNibOwjmFhwTz7gqKP8A7x—GJrUCnt... 1/3 <br />