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Email Address* <br /> Enter a valid email address in this field to receive a confirmation e-mail. <br /> skiscalpel@gmail.com <br /> Your Phone Number* <br /> Used only to follow up. <br /> 9702593450 <br /> Extension <br /> Alternate Phone Number <br /> Used only to follow up. <br /> 9702590353 <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 /> Comment/Objection Narrative* <br /> Based on the written description,the proposed drilling site is close to and in the same rock formation as my <br /> domestic water well. Drilling core holes as deep as proposed has the potential to affect our water well. <br /> Permit Number* <br /> Enter valid letter and then numbers,for example M1977999, M1999777UG or C1981201. <br /> P2023012 <br /> Permitting Action Type <br /> Select revision type or leave blank if comment pertains to a new permit application or NOI <br /> Permit Type <br /> County <br /> La Plata <br /> Enter one county only <br /> Site Name <br /> Perm ittee/Operator Name <br /> Metallic Minerals <br /> ADDITIONAL INFORMATION <br /> Are there supporting photos, maps, or documents you wish to upload? <br /> Yes No <br />