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,t ". <br />niehaN D. Lamm <br />Oowrnor <br />DEPARTMENT OF NATURAL RESOURCES <br />DavW K Galeha4 Esaeutlw Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SH~LTON, Director <br />APPLICATION FORM FOR A REYISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rute 1.04(73), technical revisions as defined in Ruie 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). A71 revisions are to address the requirements <br />of Rut a 2.08.4. <br />A71 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: _`~ / _$_/ )g46 <br />Permittee: 1~Q gZ If.~ C10AL. CEJMPAIJy_ _ <br />Street: <br />- - - - - - - - - - - - - - - <br />state: ,~ Q z/~ip code: S L~ .~ ,~- - - - -- - - - - <br />Permi t No.: C - ~ 2- ~ <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision Number _ _ (Sequential by Revision Type) <br />Revision Submittal Date _/_/ (Date Received by Division) <br />Revision Completeness Date _/ / Revision Incompleteness Oate _/ / <br />Revision Adequacy Due Date _/ / Revision Adequacy Date _/_/` <br />Revision Decision Due Date / / Fee 50.00 <br />Brief Description of Revision: 4~.~AV~ dJIV~61b~1 d/1TC1~{_wTACT_~13OVE <br />~1~1A~ #~a. Mwe 1~~. ~A~ria4J <br />Public Notice Attached -Yes _ No `(Required for PR's and TR's) <br />Bond Increase: Yes i No -~- <br />Proposed Change in; <br />Disturbed Area (+/_} _ _ ~,_ Acres Affected Area (+/-) _ _ D._ Acres <br />• Permit Area (+/ ) _ _ ~._ Acres Federal Land (+/_) _ _ O Acres <br />State Land (+/-) _ , ~ Acres Private'Land (+/-) _ _{`Z Acres <br />lead Reclamation Specialist 5; 6186E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.;(3031866-3567 <br />