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III IIIIIIIIIIIIIIII ~ <br />STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION oF.~o~ <br />Department of Natural Resources aF'~'?., <br />Nc ~ 1~ <br />t3t3 Sherman SI.. Room 215 <br />Denver, CO 60203 ~ ~ <br />303 666-3567 ~ •'. r <br />FA x: 303 632.6106 <br />RQI Romer. <br />Gavama <br />Fretl R. Banta. <br />APPLICATION FORM FOR A REVISION Division olre~aor <br />TO A COAL MI NI N6 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). Ail <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 must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not pro'~e~-'~^~-~LiOSM <br />has been provided copies. Copies should be sent certified mail. <br />SEP 2 7 1993 <br />Permit No.: C - $ ~ - 0 ~- 5 <br />Date: 0 Q/ 2 ~/ 2 3 Dmieicn ct h~:ner3is c ~ec~or,~, <br />Permittee: M I N R E C~_ I N C____________ <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />Street: ~ 7 6 8 _C o~QBs S _pg I V~',~_S ~~_~ 03,_ <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />City: G R A N D _ J U N C T I O N _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />State: C O Zip Code: 8 1 5 0 6- ______________ <br />Mine Name: FORT H_TH Of(gSON_C RE~,g_M~~f,S__ <br />Brief Description of Revision: R E M O V E_ p~ A M O jI g= A__ <br />~~R C$,I~_F$O~I_P E $~ I T <br />ARE A <br />- - - - - - - - - - - - - - - - - - <br />Public Notice Attached - Yes XX No _ (Required for PR's and TR's) <br />Bond Increase: Yes _ No X~ Federal XX Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) = 2 2.0 Acres Affected Area (+/-) _ ~. ~.0 Acres <br />Permit Area (+/-) _ ~ Q.0 Acres Federal Land (+/-) _ _ O.Q Acres <br />State Land (+/-) _ _ Q Acres Private Land (+/-) = 2 9 Acres <br />6185F (10/90) <br />