REV02700

• Permit No: C1984062
• IBM Index Class Name: Revision
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: TR6
• Media Type: D
• Archive: No

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DEPARTMENT OF NATURAL RESOURCES
Davin H. Ge[cnes. Eaecunve Oirec[or
MINED LAND RECLAMATION DI\
DAVID C. SHElTO N, Director
Ricnara D. Lamm
corarnor APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT
This form must be completed and submitted with all requests for minor revisions, as
defined in Rule 1.04(73), technical revisions as defined in Pule 1.04(36) and permit
revisions, as defined in Rule 1.04(90). All revisions are to address the requirements
of Rul a 2.08.4.
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.
Date: 1 1 / 1 6/ 9 0
Permittee: C
- O L
- - O R
- - - A D O Y A M P A
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~ ~ J,4_L_ _ C O M P A N Y_
Street: 2
- 9 5
- - 8 7
- - - R O U T T
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C
- O U
- - N T
- - - Y R O A D # 2 7
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• City: O
- A K
- - C
- - - R E E K
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State: C _O Zip Code: a 0 4 6 7 - _ _ _ _
Permit No.: C - g 4- 0 6 2
This box to be filled in by the Division:
Type of Revision: _ _ (PR, TR, or MR)
Revision Number _ _ (Sequential by Revision Type)
Revision Submittal Date / / (Date Received by Division)
P.evision Completeness Date _/ / Revision Incompleteness Date _/ /
Revision Adequacy Due Oate _/ /_ Revision Adequacy Date _/ /
Revision Decision Due Date / / Fee 50.00
Brief Description of Revision: M I
- - N E 3 5
- - - E D I
- - M E N T
- - - - - -
- -

- C O T
- - - R O L
- - - P L A
- - N
- - - - - -
- -
Public Notice Attached - Yes X No (Requir ed for PR's and TR's)
Bond Increase: Yes No X
Proposed Change in:
Disturbed Area (+/_) _ N/A . _ Acres Affected Area (+/_) _ N/A _ Acres
• Permit Area (+/-) _1A . _ Acres Federal Land (+/_) _N/p_ Acres
State Land (+/-) _ N/A Acres Private Land (+/-) N/A _ Acres
Lead Reclamation Specialist 6185E
423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. [phone]