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Richard D. Lamm <br />Governor <br />APPLICATION FORM FOR A REVISION <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 Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90). All revisions are to address the requirements <br />of Rule 2.08.4. <br />All 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: 0 6/ 1 3/ 8 9 <br />Permittee: C o L o w Y o- C ~~ ]~ -~~ <br />---- -------- - ~r~~j <br />Street: 5 7 3 1- S T ~~~_JiJoL1- ;. ~~.~_ ~ ~'' <br />- II 1 3 --- , <br />City: M E E K E R ------------- <br />State: c o Zip Code: a 1 6 4 1 - - - - - `:~=:~ <br />Permit No.: C- 8 1- 0 1 9 <br />This box to be filled in by the Division:' <br />Type of Revision: /~ Q (PR, TR, or MR) <br />Revision Number ~~ (Sequential by Revision Type) <br />R i Sbi 1 (D R i db Di ii ) <br />evi s on u m tta Date ~/~/~ ate ece ve y v s on , <br />Revision Completeness Date ~/~/~ Revision Incompleteness Date ~, <br />Revision Adequacy Due Date _/ / Revision Adequacy Date -/ / <br />Revision Decision Due Date (, /]"S/g°1 Fee 50.00 <br />Brief Description of Revision: E x r L o R n T i o N-_-- <br />D R I L L I N G <br />- - - - - - - - - - - - - - - - - <br />Public Notice Attached - Yes _ No x (Required for PR's and TR's) <br />Bond Increase: Yes ~ No <br />Proposed Change in: <br />Disturbed Area (+/_) - _ 3 , 3 Acres Affected Area (+/-) - - y .~ Acres <br />Permit Area (+/-) _ _ _ _ Acres Federal Land (+/-) _ _ _ Acres <br />State Land (+/-) - - - Acres Private Land (+/-) - - - Acres <br />Lead Reclamation Specialist Mr. To_y Waldron 6185E <br />~\1 <br />' `~a ~\. <br />tl <br />l~~kb~~s~~~ <br />Q~~~ <br />~ ~$~ <br />e 2~ b <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866-3567 <br />DEPARTMENT OF NATURAL RESOURCES <br />David H. Getehea. Esecurive Director <br />MINED LAND RECLAMATION DI\ <br />DAYID C. SHELTON, Director <br />iii iiiiiiiiniiiiii <br />999 <br />