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10/28/2019 Annual Report ePermitting Change Form-Google Forms <br /> 4nnual Report ePermitting <br /> QUESTIONS RESPONSES <br /> 68 responses <br /> SUMMARY Accepting responses • <br /> -mob.. <br /> 68 of 68 ■ <br /> Responses cannot be edited <br /> ePermitting Administrator Change Form <br /> R e q Lli�",q d <br /> C 0 L 0 R A D 0 <br /> Division of Reclamation, <br /> TIA Mining and Safety <br /> Dcpartmcnt of Natural Rcsou-rces <br /> Please complete this form to update the ePermitting Administrator for submittal of annual <br /> reports and fees. This form is for changing the name and/or email address of the <br /> administrator on existing ePermitting accounts. You will receive an email confirming your <br /> chanrips within two bu-qinP-q-q days. <br /> Name of Permittee or N01 Holder: <br /> Steven Calkins <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> M-1 991-097)M-1 978-268 <br /> .................................... ............... <br /> https:Hdocs.googIe.com/forms/d/1 QY6 C 6w2 B M yQoAm u 1—D FtS 5wV H I fo e U ra Q e P xve h J J a c/e d i t#res p o n s e=ACY D B N g 6 OwC n F s—1 7TV KYV3 P pvce S a s b... 1/3 <br />