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•° <br />STATE OF COLORADO <br />Roy Romer, Govei <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION DIVISION <br />FRED R. BANTA, Director APPLICATION FORM FORA REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as <br />defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. <br />Three copies of your revision including maps must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is being <br />revised. The revision date should be printed in the lower right corner of the revision <br />pages. If necessary, the Table of Contents should also be revised. When the final version <br />of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Date: d !i/ f ~/ q 3 <br />Permittee: 5 1 u r c o- G Q Q ,~ - <br />- - - - - - - - - - - - - - - <br />Street: 4 0 - $ o cL - ? $ ~ 3 c ~ - - <br />- RFG~ IvF~. <br />--------------- <br />City: L q K E v o v U____ _ __ <br />state: G p Zip Code: ~ ~ z Z ~ - ~ 3 0 ~ - ~{IN 22 1993 <br />Permi t No.: C - 8" 1 - Q 2 ~ Division o: hhag,~,~ ~ ~eU1cy; <br />PoineName: C~~~~J..~UV-~S R1 P ------ <br />1s box to be rltleo 1n oy the o1v1s1on: <br />Type of Revision: - - (PR, TR, or MR) <br />Revision Number: (Sequential by Revision Type) <br />Rev. Submittal Date: _ _/_ _/_ _ (Date Received by Division) <br />Rev. Completeness Date: - -/- -/- - Rev. Incompleteness Date: - -/- -/_ - <br />Rev. Adequacy Due Date: - -/- -/- - Rev, Adequacy Date: - -/- -/- - <br />Rev. Decision Due Date: - -/- -/- - Lead Reclamation Specialist: - - - <br />r1e escrlp ton o evlslon: ~ E 6 D - ~ o ~ rt K e ~ - - - <br />Public Plotice Attached - Yes - ~o (~equ1 rem ~r~R s and~R s )- - - <br />Bond Increase: Yes No ~ Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) Q . Acres Affected Area (+/-) p. Acres <br />Permit Area (+/-) - - o .- Acres Federal Land (+/-) - - o - Acres <br />State Land (+/-) _ _ Q - Acres Private Land (+/-) _ _ Q Acres <br />6185E (Rev. 10/88) <br />215 Centennial Building, 1313 Sherma n Street Denver, Colorado 80203.2273 T el. (303) 866-3567 <br />