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C O L O R A D O <br /> Division of Reclamation, <br /> A7Mining and Safety <br /> By Submitting this form you are requesting an investigation of <br /> compliance oath DRMS rules. <br /> DBMS Internal Information <br /> Select Permit Type <br /> Minerals <br /> Permit No List <br /> M1985112 <br /> Date of Complaint <br /> 10/14/2019 <br /> CPMO,AV+1i4W 10WOOMAM M <br /> Indicates a Required Field <br /> Do you wish to remain anonymous? <br /> !' Yes r No <br /> Connection to Incident <br /> Select all that apply <br /> P Land Owner r Mineral Owner <br /> r Nearby Resident W Observed Incident <br /> (1 Other <br /> A+ <br /> lease be as s etc as posAley <br /> Note Please provide as much detail related to location and issue as possible Without enough detail, DRMS will not be <br /> able to process or investigate the complaint and, therefore, DRMS will have no choice but to discard the complaint. <br /> Location of Concern* <br /> Please provide as much detail as possible. It is important to narrow down the location. If available,please include Township, <br /> Range and Section, physical address,or GPS location.You may also upload a pdf map below. <br /> (North)Koehler property 1001 East C Street(WCR 62)Greeley, Hoshiko Property north side of Loloff pit, <br /> Sylvia Parker <br /> (South)Taylor, Francis, Monroe,Tyrrell <br /> (West)Stout,Hernadez]Paima,Rothe and Harrell <br /> See the descriptions with the attached <br /> Incident County <br /> Weld County <br /> Is this an ongoing issue(s)? <br /> r Yes r No <br /> Nature of Complaint* <br />