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6/9/22,2:08 PM Annual Report ePermitting Signup <br /> Annual Report ePermitting Signup <br /> COLORADO <br /> Division of Reclamation,, <br /> t� <br /> ' Mining and Safety <br /> D partme nt of Natural resources <br /> Please complete this form to create a new ePermitting account for submittal of annual <br /> reports and fees. You will receive an email with your login information within two business <br /> days. This form is for new ePermitting account activation. If you have already enrolled in <br /> ePermitting, you should not complete this form. <br /> Name of Permittee or NOI Holder: <br /> BrokenBox LLC <br /> ......................................................................................................................................................................................................................................................................................................................................................... <br /> Street Address: <br /> 4600 E Highway 40 <br /> https://docs.google.com/forms/d/1 IrxOW3YTBhUgGtgfeXDsK5GkvVjw_jFE-9jmiKZURFs/edit#response=ACYDBNinejx3Ov53_4F50pBV6YZBLnjuexY... 1/4 <br />