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,~'~ pF c~CCJJp"P <br />Q '~Y~.n1 YO <br />~~p DEPARTMENT OF NATURAL RESOURCES <br />~ f o ~` i y David H. Geichea. Eaecutrve Director <br />`:~'~` MINED LAND RECLAMATION Dl\ <br />x876 <br />DAVID C. SHELTO N, Director <br />Richartl D Lamm <br />Doverrtor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAI4A7ION PERMIT <br />This form must be completed and~submltted with all requests for minor revisions, as <br />defined in Rule 1.04(13), technical revisions as defined in Pule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <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 <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. if necessary, the Table of Contents should also be revised. <br />Date: 0 9/ 1 9/ 8 6 <br />Permittee: P e a b o d y C o a l <br />- - - - - - - - - - - - - - - <br />C o mp a n y <br />- - - - - - - - - - - - - - - <br />Street: 1 3 0 0 S o u t fl Y a l e <br />- - - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - - <br />C1ty: F 1 a g s t o f f __ _______ <br />• State: A Z Zip Code: 8 6 0 0 1= <br />Permit No.: C - 005 - 8 0 <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or hIR) <br />Revision Number _ _ (Sequential by P,evision Type) <br />Revision Submittal Date _/ / (Date Received by Division) <br />P,evision Completeness Date _/ / Revision Incompleteness Date _/_/ <br />Revision Adequacy Due Date _/_/_ Revision Adequacy Date _/_/_ <br />Revision Decision Due Date / / fee b0.00 <br />Brief Description of Revision: A d d N e w T o p s o i l <br />- - - - - - - - - - - - - - - <br />S t o c k p i l e <br />- - - - - - - - - - - - - - - - - <br />Public Notice Attached - Yes _ No XX (P.equired for PR's and TR's) <br />Bond Increase: Yes _ No XX <br />Proposed Change in: N/A <br />Disturbed Area (+/-) _ _ _ _ Acres Affected Area (+/-) _ _ _ _ Acres <br />• Permit Area (+/-) _ _ _ _ Acres Federal Land (+/_) _ _ _ Acres <br />State Land (+/-) Acres Private Land (+/_) Acres <br />Lead Reclamation Specialist 6185E <br />423 Centennial Building, 1313 Sherman Slreel Denver, Colorado 80203 Tel. (303) 8663567 <br />