REV01207

• Permit No: C1981022
• IBM Index Class Name: Revision
• Doc Name: REQUEST FOR AVS COMPLIANCE CHECKS
• Type & Sequence: PR4
• Media Type: D
• Archive: No

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REQUEST FOR AVS COMPLIANCE CHECKS
Permit No: (~- ~~ - (~,2~ Application Type & #: ~~
Applicant: C ~{4L MSHAIdNo.: f1S-oo2gV~-su,-{-.[z,Uld~~s
~ S- O `14 5 Z S^ ^ bu• n ~rwA.- t"t'~µ-
lsr Check: Adequacy of application (within 30 days of completeness)
Date AVS: g_ Date OSM: 9 ~t
AVS Evaluation: tb Q rMs
OSM Evaluation: 0 l to Q CYI-S
DMG Recommendation: T~SUP .
Attach a current list of the owners and controllers for the applicant and the operators, as required
by Rule 2.03.4, Identification of Interests. If applicable, a list of permits held by the applicant in
other states, by numbers and state codes.
Note: Once you get the new information back from the operator on any AVS questions or concerns,
please give to AVS person to make sure the concerns have been fixed and AVS can be updated.
AVS Evaluatton:
OSM Evaluation: t
DMG Recommendation: Z~',l .l ~,
2"d Check: Proposed Decision of application (3-5 days prior)
Date AVS: I ~ I lL ~Cc~ Date OSM: ~ O
3rd Check: Issuance of application (3-5 days prior)
Date AVS:
AVS Evaluation:
OSM Evaluation:
Date OSM:
DMG Recommendation:
Final Check: After Issue/Decision timeframes aze over
Date of Issue/Decision:
Permit Expiration:
Permitted Acres:
`••A VS checks are required for new permit, permit revision, permit renewal, and permit transfer/succession of
operator. AVS checks are also for SOAP applications and state contracts.
M:\coaRshareVormsUtequest (or AVS Compliance Checks.doc