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Permit Number* (?) <br /> Enter a valid permit number <br /> M1977410 <br /> Revision Type and Sequence* <br /> Conversion application from a 110(2)permit to a 112d-3 <br /> designated mining operation permit. <br /> County* <br /> Colorado County where the proposed operation is located <br /> Boulder <br /> Enter one county only <br /> Site Name <br /> Permittee/Operator Name <br /> ADDITIONAL INFORMATION <br /> Are there supporting photos, maps, or documents you wish to upload? <br /> Yes • No <br /> By submitting this form electronically you agree to receive any/all follow up correspondence from the Division of <br /> Reclamation, Mining,and Safety at the email address you have provided. <br />