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Your City <br /> Jamestown <br /> Your State <br /> CO <br /> Your Zip Code <br /> Maximum of 10 digits. (Example)80202 <br /> 80455 <br /> Email Address <br /> Enter a valid email address in this field to receive a confirmation e-mail. <br /> zydecopam@gmail.com <br /> Your Phone Number* <br /> Used only to follow up. <br /> 3034438580 <br /> Extension <br /> Alternate Phone Number <br /> Used only to follow up. <br /> 9703890964 <br /> Alternate Phone Extension <br /> Connection to Operation <br /> Select all that apply <br /> Land Owner of affected land O✓ Structure Owner within 200' of affected land <br /> Mineral Owner O✓ Nearby Resident <br /> Adjacent Land Owner FA 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 /> Comment/Objection Narrative* <br /> See attached pdf file. <br /> Permit Number* <br /> Enter valid letter and then numbers,for example M1977999, M1999777UG or C1981201. <br /> M1994117 <br /> Permitting Action Type <br /> Change of Status <br /> Select revision type or leave blank if comment pertains to a new permit application or NOI <br /> Permitting Action Sequence* <br /> 1 <br /> Permit Type <br /> designated mining/milling operation <br />