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Or ~~lp <br />~`' COLORADO DIVISION OF MINERALS AND GEOLOGY <br />• 1313 Sherman Stre ,Room 215, Denver, Colorado 80203, (303) 866-3567 <br />• ~er6 • <br />RECEI~,~ <br />APPLICATION FORM FOR A REVISION RE~r~~ ~;'': <br />TO A COAL MINING AND RECLAMATION PERMIT MAY 13 2004 <br />MAY f ? ~' ~"~ <br />Dirisiart of Minerals and Geology <br />This form must be completed and submitted with all requests for minor revisions, as defi~NtiEige1:04(:731;tc~ly <br />technical revisions, as defined in Rule 1.04{736), and permit revisions, as defined in Rule 1.04190). All <br />revisions are to address the requirements of Rule 2.08.4. Three (31 copies of the revision, including maps, <br />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 replace the revised sections, maps, <br />tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should he <br />printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature <br />of the revision and reference the specific permit sections being revised. <br />For tederal mines, a copy of the revision application must be submitted to all agencies on the federal mailing <br />list (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - $0 - DO~a Date: D$ / 12 / Oy <br />Permittee: <br />Street: <br />City: <br />State: <br />FL.nRF_AtCF_ ~ ~ ~ t 22~ <br />Zip <br />Brief Description of Revision: (Z<_LIFtMAT10AI GRAZIA/G 1~f.Ar~) <br />yE~R ~DO~ <br />Public Notice Attached: Yes _ No _ /Required for PRs and TRsI <br />Bond Increase: Yes _ No ~ Federal Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) ~ _ ~ ~ Acres Affected Area (+/-) ~ _ ° ° Acres <br />Permit Area (+/-) ~ _ d . o Acres Federal Land (+/-) _ _ O ~ Acres <br />State Land (+/-) _ _ o o Acres Private Land (+/-) ~ _ ~ . ~ Acres <br />