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.; STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY _ .Department of Natural Resources ~ I J 1 l Sherman SL, Room 215 y Denver, Colorado 80203 Il ~~~ Phone: (30J) 866-3567 I FA%:13031832-8106 APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT DEPARTMENT OF NATURAL RESOURCES This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer Rule 1.04173), technical revisions, as defined in Rule 1.0411361, and permit revisions, as defined Governor in Rule 1.04(90). All revisions are to address the requirements of Rule 2.09.4. Three 131 copies h ~ of the revision, including maps, must be submitted in order for it to be complete. Executive Di ecior Michael B. Long - Division Direnur 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 revisi on 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 11999 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- 9 2 Permittee: H A Y . 0 D 8 E 1 N Date: G 0 1/ 3 U L C H 0/ 9 - 6 - ~"S T E R Street: 1 3 0 --- M 0 - I - N S - - A L 0 U -- _ I N C T H Y ---- A L -- °Cr'•FI1JFp E JAN 31 1996 - - - - - - - - - - - - - - - vision of Minerals & Geology City: F L A G S T A F F--- -- - State: A Z Zip Code: 8 6 0 0 t_- --- Brief Description of Revision: rt I D T E R M - R E V I E W R - E S - - P 0 N S - - - - E S - - - - - - - Public Notice Attached: Yes x N - o - - - - - - - - - /Required for PRs and TRsJ - - - - - Bond Increase: Yes R No Federal Non-Federal x Mine Proposed Change in: .Disturbed Area (+/-) - - o ~ Acres Affected Area (+/-) - - ~ ~ Acres Permit Area (+/-) - - ~ ~ Acres Federal Land (+/-) - - ~ ~ Acres State Land 1+/-) - - 0 0 Acres Private Land (+/-) - - 0 . 0 Acres m:\co al\s h a re\f o rms\8865