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9/8/22,2:52 PM Annual Report ePermitting Change Form-Google Forms <br /> r p � D <br /> Annual Report ePermitting Change Form <br /> Questions Responses ono Settings <br /> C 0 L 0 R A D 0 <br /> Division of Reclamation, <br /> Ala I(D dining 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 /> Steve DiCamillo <br /> ............................................................................................................................................................................ <br /> Permit/N01 Numbers (ie M-1987-189, P-2016-026): <br /> M1993039 <br /> ............................................................................................................................................................................ <br /> ePermit Number: <br /> https://docs.google.com/forms/d/1 QY6C6w2BMyQoAmu1_DFtS5wVHIfoeUraQePxvehJJac/edit#response=ACYDBNhHs3upWM-KEkgCCrdZvNIBZz... 1/2 <br />