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10/28/2019 Annual Report ePermitting Change Form-Google Forms <br /> 4nnual Report ePermitting <br /> QUESTIONS RESPONSES <br /> 69 responses <br /> SUMMARY • <br /> Accepting responses <br /> 67 of 69 > ■ <br /> Responses cannot be edited <br /> ePermittingAdministrator Change Form <br /> IRegLli"cgcw <br /> C 0 L 0 R A D 0 <br /> Division of Reclamation, <br /> TIA Mining and Safety <br /> p r#tmcnt 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-ginP-q-q nays. <br /> Name of Permittee or N01 Holder: <br /> Shell Frontier Oil&Gas Inc. <br /> ................... ................. ............................... <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> P-2003-015, P-2003-018,P-2004-011, P-2005-001,P-2005-002, P-2006-013,P-2006-036,P-2007-010,P-2010-026, P-2003- <br /> 022, P-2006-037,P-2005-017 <br /> ............................... .................. <br /> https:Hdocs.googIe.com/forms/d/1QY6C6w2BMyQoAmu1_DFtS5wVHIfoeUraQePxvehJJac/edit#response=ACYDBNiYzLsZ71Cw wKD3P-pv8N3L5q... 1/3 <br />