REV00797

• Permit No: C1981013
• IBM Index Class Name: Revision
• Doc Date: 4/1/1992
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: TR18
• Media Type: D
• Archive: No

iii iiiiiiiiiiiii iii
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STATE OF COLORADO
t •~~, d ~• Roy Romer, Governor
~I'' - u
DEPARTMENT OF NATURAL RESOURCES ~ ~°
MINED LAND RECLAMATION DIVISION ~" ~,,
. , ,-~-~ ,
FRED R. BANTA, Dtneto' APPLICATION FORM FOR A REV ISION ~ '
TO .A COAL MINING AND RECLAMATION PERMIT ~~%
This form must be completed and submitted with all requests for minor revisions, as define:
in Rule 1.04(73), technical revisions as defined in 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.
Three copies of your revision including maps must be submitted in order for it to be complete.
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 is 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. 'dhen the fi,^,a1 version
of the revision is approved, 7 copies must be .sent to OSF1 in Denver for Federal mines and for
non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New ttexico 87102. The revision may not proceed until OSM has been provided
copies. Copies should be sent certified mail,
Date: Q ~/ L ~/ .~r F ~~••
Pe-mittee: ~j lr' .~ ,L ~ .~'~S 1211 g S.r<,~ ~°~C~~~~~
-'~--.~~G~----------
'~_.treet: ~Q~~s? -lil~ti~~~~ Z APR 01199?
___ ___________ dine nd
city: I~ ~ ~ ~- ~- - - - - - - - - - - -Rer,~amaran n;,,:,.;,~n
State: ~ Q Zip Code: ~ L .~~ L " - - - -
t4ine Name: ~rCZS--/~~LC .~~~~L---------
ts ox o e t e to y e tvtston•
Type of Revision: ~~ (PR, TR, or MR)•
Revision Number: ~ ~ (Sequential by Revision Type)
Rev. Submittal Date: _ _/_ _/_ _ (Date Received by Division)
Rev, Completeness Date: - -/- -/- - Rev. Incompleteness Date: - -/- -/- -
Rev. Adequacy Due Oate: - -/- -/ - Rev. Adequacy Date: - -/- -/- -
Rev. decision Due Date: - -/ _/ _ Lead Reclamation Specialist: - - -
rte escrtp ton o evtston: - ~ ~ j _ -
Public Notice Attached - Yeses ~ ~1o~~(Req~re~ 1~~R~and~~ ~~~'~
Bond Increase: Yes Flo ~ -Federal ~ tlon-Federal h!ine
proposed Change in:
sturbed Area (+/-) d . Acres Affected Area
('rermit Area (+/-) - - ~.- Acres Federal Land
State Land (+/_) - - -_ - Acres Private Land
6185E (Rev. 10/88)
2t5 Centennial Building, t3t3 Sherman Street
(+/-) ~. Acres
(+/_) - _ - - Acres
(+/_) - Acres
Denver, Colorado 80203-2273 Tel. [phone]