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Email Address* <br /> Enter a valid email address in this field to receive a confirmation e-mail. <br /> hbram.slikker@icloud.com <br /> Your Phone Number* <br /> Used only to follow up. <br /> 9728349061 <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 Structure Owner within 200' of affected land <br /> Mineral Owner ✓ Nearby Resident <br /> Adjacent Land Owner Concerned Citizen <br /> Government Agency Other <br /> DESCRIPTION OF COMMENT OR OBJECTION <br /> You are providing a comment or objection to the public record of a permitting action currently under review by the Division of <br /> Reclamation, Mining and Safety.This form is not intended for reporting of possible violations or illegal activity. Please be as specific <br /> as possible. <br />