PERMFILE70512

• Permit No: C1981014
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Doc Name: MR-14 to MR-20
• Section_Exhibit Name: EXHIBIT 15 Part 3
• Media Type: D
• Archive: No

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STATE OF COLORADO
Roy Romer, Gove.
DEPARTMENT OF NATURAL RESOURCES
MINED LAND RECLAMATION DIVISION
FRED R. BANTA, Dinetor
APPLICATION FORM FORA REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as
defined in Rule 1.04(73), technical revisions as defined 1n Rule 1.04(36) and
permit revisions. as defined in Rule 1.04(90). All revisions are to address the
requirements of Rule 2.08.4.
All revisions are to be formatted so they can be inserted into the permit to
replace the revised sections, maps, tables and/or figures. Explain in the revision
what section 1s being revised. The revision date should be printed in the lower
right corner of the revision pages. If necessary, the Table of Contents should
also be revised.
Date: _ _/ /
Permlttee: - - - -
• Street: ---------------
City: --------------------
State: - - Zip Code: _ - - - _ - _ _ _ _
Permit No.: C - -
s ox e e n y t e v s on:
Type of Revision: - - (PR, TR. or MR)
Revision Number - - (Sequential by Revision Type)
Revision Submittal Date -/ / (Date Received by Dl vision)
Revision Completeness Date -/ / Revision Incompleteness Date -/-/-
Revision Adequacy Due Date -/ / Revision Adequacy Date -/ /-
Revision Decision Due Date / / Fee =0.00
rtef Descrtptton of Itevtston:
- - - - - - - - - - - - - - - - -
Public Notice Attached - Yes _ No -(Required for PR's and TR's)
Bond Increase: Yes No
Proposed Change 1n:
• Disturbed Area (+/_) - - - - Acres Affected Area (+/-) - - -,- Acres
Permit Area (+/-) _ _ _ _ Acres Federal Land (±/-) _ _ _ Acres
State Land (+/-) _ _ _ Acres Private Land (+/-) _ _ _ Acres
Lead Reclamation Specialist - - - 6185E
423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203-2273 Tel. [phone]