Laserfiche WebLink
COLORADO <br /> DRMS Complaint Intake ToolA 4 ateDivision of Reclamation, <br /> P 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 /> COMPLAINANT INFORMATION <br /> Date of Complaint <br /> 05/28/2020 <br /> *Indicates a Required Field <br /> Do you wish to remain anonymous? <br /> Yes No <br /> Your First Name <br /> yvonne <br /> Your Last Name <br /> simmons <br /> Your Address <br /> 6491 townsend road <br /> Your City <br /> delta <br /> Your State <br /> co <br /> Your Zip Code <br /> Maximum of 10 digits. (Example)80202 <br /> 81416 <br /> Email Address* <br /> Enter a valid email address in this field to receive a confirmation e-mail and copy of your Complaint form. <br /> simmonsagency@aol.com <br /> Your Phone Number* <br /> Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br /> 970-250-3158 <br /> Alternate Phone Number <br /> Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890 <br /> Connection to Incident <br /> Select all that apply <br /> Land Owner Mineral Owner <br /> Nearby Resident Observed Incident <br /> Other <br />