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STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY Depanment of Natural Rewurces 1713 Sherman SI.. Room 215 Denier. Colorado 80203 r-,r.tell/ Phone: [3071866.3567 St;l' FAX: 130318)28106 APPLICATION FORM FOR A REVISION ~ g TO A COAL MINING AND RECLAMATION PERMIT DiviSi~i~ ~, ~ .. 9 arc ~ This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer Rule 7.041731, technical revisions, as defined in Rule 1.0411361, and permk revisions, as defined cO1""D` in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three (31 copies ume+5. Lochneatf Eaecunve Director of the revision, including maps, must be submitted in order for it to be complete. Nucheel 8. Lone Divitim Director All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Western Regional Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C -~ 1 -~ 7 1 Date: 0 9/ 7 2 / 9 6 Permittee: C O ~ O R ~_ D 0 _~ A 61 P~ C O A ~_ C O II P A P Y Street: R O U T T _ C O U N ~ Y_ R O A D _ # 2 7 City: O A I( _ C R A E ~______ State: C O Zip Code: 8 0 4 6 7- Brief Description of Revision: Public Notice Attached: Yes 1994 MID-TERM REVIEW RESPONSE, TEXT CONSOLIDATION No X (Required for PRs and TRs) Bond Increase: Yes No X Proposed Change in: Disturbed Area (+/-) Permit Area (+l-) _ 0 0 Federal X Non-Federal _ Mine ~ Acres Affected Area (+/_) _ _ 0 0 Acres ~ Acres Federal Land (+/_) _ _ 0 0 Acres State Land (+/_) _ _ 0 0 Acres Private Land (+/_) _ _ ~ ~ Acres m •lcoallsha relforns18866