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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION ,-aF.~o~ <br />Department of Natural Resources RE A,, <br />7373 Sherman St., Roam 275 „~~18 <br />Denver, CO 80203 • '+° ` <br />303 866-3567 ~ ~r87a. <br />Fax: 303 832-8706 <br />Rv, Romer. <br />Gwemar <br />' Fred R. 6ama. <br />APPLICATION FORM FOR A REVISION ofvision olrector <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br />your revision including maps must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy nest be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C - $ O - O Q ,~ <br />Date: 11 Q/ 3 O/ ~ ,L <br />Permittee: S g. LZ-~'2 E ~ K----- <br />l~l.11a1~z_ ~o------ <br />Street: (~Q~(-7Q--------- <br />- - - - - - - - - - - - - - - <br />c;ty: L~M~-- ------------- <br />State: ~ Q Zip Code: 8 L .~ ? ~. - Q Q ~ Q <br />Mine Name: M ~C~~~~- C~i( ~Q~(------ <br />Brief Description of Revision: 1 nl c t D € ~ _ ~, ~- ~ONNp,4eJ <br />rrh~_t~}_~z~-~-9L~arJ., ~ ~ 11 <br />Public Notice Attached -Yes ~ No _ (Required for PR's and TR's} <br />Bond Increase: Yes No ~ Federal ~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - - Q.Q Acres Affected Area (+/-) - Z ~. 3 Acres <br />Permit Area (+/-) _ ~ ~.~ Acres Federal Land (+/_) - Z 6 3 Acres <br />State Land (+/-) - - Q Acres Private Land (+/-) - - Q Acres <br />6185E (10/90) <br />