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11/1/2019 Coal Program ePermitting Signup-Google Forms <br /> Please complete this foll I I I LU Wt::C[Le a new :::PerrT]I LLI I y account to <br /> access ePermitting forms. You will receive an email with your login <br /> information within two business days. This form is for new <br /> ePermitting account activation. If you have already enrolled in <br /> ePermitting) you should not complete this form. <br /> Name of Permittee: <br /> C.B. Minerals, LLC <br /> ......................................................................................................................................................... <br /> Street Address: , <br /> 2352 N 7th Street, Unit B <br /> I....................................... ................................................................................... <br /> City: <br /> Grand Junction <br /> .......................................................................................................................................................... <br /> State: <br /> CO <br /> ...................................................................................................................................................... <br /> Zip: <br /> 81501 <br /> ................................................................................................................... <br /> https://docs.google.com/forms/d/l kFaOUGYvneqHl8rVn6BXL7—wkTUQtHPvUij8w6F—MaE/edit#response=ACYDBNhMQsZ9NiqcUGIKnoldDHUEyqw... 2/4 <br />