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5/14/2021 Annual Report ePermitting Signup-Google Forms <br /> Please complete this form to create a new ePermitting account for submittal of annual reports <br /> and fees. You will receive an email with your login information within two business days. This <br /> form is for new ePermitting account activation. If you have already enrolled in ePermitting, you <br /> should not complete this form. <br /> Name of Permittee or NOI Holder: <br /> Heartland Aggregate Mining <br /> l .................................................................................................................................................................................... <br /> Street Address: <br /> 1215 Platte Drive <br /> City: <br /> Fairplay <br /> .................................................................................................................................................................................... <br /> State: * <br /> Colorado <br /> Zip: <br /> 80440 <br /> Telephone: <br /> 970-319-0076 <br /> .................................................................................................................................................................................... <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit?urlBuilderpomain=state.co.us#response=ACYDBNhSsK... 2/4 <br />