Address Location Form for Underground Mining Information

Address Location Form for Underground Mining Information

THIS IS AN INFORMAL REQUEST FOR INFORMATION AND NOT A REQUEST FOR INFORMATION UNDER THE RIGHT TO KNOW LAW. USE THE FOLLOWING E-MAIL ADDRESS TO REQUEST INFORMATION FROM DEP UNDER THE RIGHT TO KNOW LAW: EP-DEP-RTK@pa.gov If you have problems with this form, please call 888-357-2674 or email questions to ra-epmsi@pa.gov

First Name

Last Name

Confirm Email

Address

City

State

Zip Code

Municipality

County

Daytime Phone Type

Daytime Phone Number (XXX-XXX-XXXX)

Nearest Street Intersection

Rural Route Address

Additional Comments

Generate a new image Play the audio code

Enter the code from the image