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9/8/22, 12:37 PM Annual Report ePermitting Change Form-Google Forms <br /> p <D D <br /> Annual Report ePermitting Change Form <br /> Questions Responses Settings <br /> �4' WA moD1vT1 1 I"� f lamatl l�, <br /> TM Mining and Safety <br /> Department of Natural Resources <br /> Please complete this form to update the ePermitting Administrator for submittal of annual <br /> reports and fees. This form is for changing the name and/or email address of the administrator <br /> on existing ePermitting accounts. You will receive an email confirming your changes within two <br /> business days. <br /> Name of Permittee or N01 Holder: <br /> Cobalt Cattle Company <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> M-2016-040 <br /> ePermit Number: <br /> 558617 <br /> I nn+ Alnrvn of ;-A;,A,4..,I —k- -All nn+ fnr+hn nDnrrvi++inn nnnn n+• <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHIfoeUraQePxvehJJac/edit#response=ACYDBNhRe4iVj-ylHunAl8P_INaXOMZo... 1/2 <br />