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1/21/22, 11:27 AM Annual Report ePermitting Signup-Google Forms <br /> Permit/NOI Numbers (ie M-1987-189, P-2016-026): <br /> M-1977-410 <br /> ................................................................................................................................................................................ <br /> Last Name of individual who will act as account administrator for the ePermitting account: <br /> MITTASCH <br /> First Name of individual who will act as account administrator for the ePermitting account: <br /> RICHARD <br /> ................................................................................................................................................................................ <br /> Email address of account administrator: * <br /> The account administrator is responsible for providing the Division with a current email address for ePermitting <br /> correspondence. Please contact the Division if an existing administrator email requires updating. <br /> rmittasch@nedmining.com <br /> ................................................................................................................................................................................ <br /> Name(s) and Permit Number(s) of any additional person(s) to notify on annual report/map/fee <br /> due date(s): <br /> ................................................................................................................................................................................ <br /> Email address(es) of additional person(s) to notify on annual report/map/fee due date(s): <br /> ................................................................................................................................................................................ <br /> https://docs.google.com/forms/d/1 lrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNggjnj8oK5wia5VkD7mysiQtY7_5wP... 3/4 <br />