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Connection to Incident <br /> Select all that apply <br /> ✓ Land Owner Mineral Owner <br /> ✓ Nearby Resident Observed Incident <br /> ✓ Other Neighboring Business Owner(tourism) <br /> DESCRIPTION OF COMPLAINT <br /> (Please be as specific as possible) <br /> Note:You are requesting an investigation of a compliance issue with DRMS rules. This form is not intended for <br /> comments or objections on permitting actions under review. Please provide as much detail related to location and issue <br /> as possible.Without enough detail, DRMS will not be able to process or investigate the complaint and,therefore, DRMS <br /> will have no choice but to discard the complaint. <br /> Location of Concern* <br /> Please provide as much detail as possible. It is important to narrow down the location. If available,please include Township, Range <br /> and Section, physical address,or GPS location.You may also upload a pdf map below. <br /> The DMRS Permit Number is: M2020021 <br /> Location of gravel operation of concern: 180132 HWY 160,SOUTH FORK,COLORADO 81154 <br /> Parcel Number 5119-244-00-002 <br /> Legal Summary N/2SE/4 SEC.24 T39N R2E <br /> Google Map approximate coordinates:37.609209,-106.713560 <br /> Owners: Dianna Mouse: MOUSE BRET&DIANNA REVOCABLE LIVING TRUST <br /> P.O. BOX 722410 <br /> NORMAN, OK 79070 <br /> Incident County <br /> Mineral County <br /> Is this an ongoing issue(s)? <br /> Yes No <br /> Nature of Complaint <br /> Select all that apply <br /> ✓ Illegal Mining ✓ Dust <br /> Ground Water/Water Well Impact Acid or Toxic Materials/Spills <br /> Surface Water Impact/Stormwater Management ✓ Property Damage <br /> ✓ Mine Plan Compliance Waste Management/ Dumping <br /> Signs and Markers Overburden/ Development Waste <br /> Financial Warranty Backfilling and Grading <br /> Processing Waste/Tailings Processing Facilities <br /> Fish /Wildlife Erosion/ Sedimentation <br /> ✓ Off-Site Damage Roads <br /> Explosives/ Blasting Topsoil <br /> Revegetation Weeds <br /> Reclamation Plan Compliance ✓ Other Traffic and dust is destroying neighboring <br /> tourism business <br />