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------ --- --------- -- <br /> COLORADO <br /> DRMS Complaint Intake Tool �,,�,,,/ Division of Reclamation, <br /> 1 co �1+� Mining and Safety <br /> Department of Natural Resources <br /> By Submitting this form you are requesting an investigation <br /> of compliance with DRMS rules. <br /> de jo <br /> COMPLAIMAW NFi©RMATI014 <br /> Date of Complaint <br /> 10/14/2019 <br /> Indicates a Required Field <br /> Do you wish to remain anonymous? <br /> r Yes r' No <br /> Your First Name <br /> Mel <br /> Your Last Name <br /> Bickling <br /> Your Address <br /> 6690 Lakota Ct <br /> Your City <br /> Loveland <br /> Your State <br /> CO <br /> Your Zip Code <br /> 80534 <br /> Email Address <br /> E"'i0-, "'d :. <br /> mbick7077 ct outlook.com <br /> Your Phone Number* <br /> u, ,, ;/ t.rr ,,. „ t•.. Sc. ,...,t. <br /> 970-227-8420 <br /> Alternate Phone Number <br /> tl. , t. , , ., ._ r,--, t f r , . f.,.. , i. , ,—, . <br /> Connection to Incident <br /> W Land Owner ( Mineral Owner <br /> r Nearby Resident FJ Observed Incident <br /> W Other <br />