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Your Phone Number * <br />Used only to follow up. <br />8005004001 <br />Extension <br />Alternate Phone Number <br />Used only to follow up. <br />Alternate Phone Extension <br />Connection to Operation * <br />Select all that apply <br />� Land Owner of affected land <br />Mineral Owner <br />Adjacent Land Owner <br />Government Agency <br />Structure Owner within 200' of affected land <br />Nearby Resident <br />Concerned Citizen <br />Other <br />DESCRIPTION OF COMMENT OR OBJECTION <br />(Please be as speciflc as possible) <br />Comment/Objection Narrative * <br />Test <br />Permit Number'k <br />Enter valid letter and then numbers, for example M2021208 or C1981201. <br />C1980004 <br />Permitting Action Type <br />Minor Revision <br />Select revision type or leave blank if comment pertains to a new permit application or NOI <br />Permitting Action Sequence * <br />888 <br />Permit Type <br />MR <br />County * <br />Enter one county only <br />Boulder <br />Site Name <br />Test <br />Permittee/Operator Name <br />Test <br />ADDITIONAL INFORMATION <br />Are there supporting photos, maps, or documents you wish to upload? * <br />Yes No <br />