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~ STATE O~COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmem al Natural Resource <br />1717 Sherman Si., Room 115 <br />Oenver, Colorado 80107 <br />Phone: 13071 888-3587 <br />FAX: 170)1 871.8106 <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMITA <br />Division of <br />This form must be completed and submitted with all requests for minor revisions, <br />Rule 1.041731, technical revisions, as defined in Rule 7.04(1361, and permit revisior <br />in Rule 1.04(901• All revisions are to address the requirements of Rule 2.08.4. Three 731 copies <br />of the revision, including maps, must be submitted in order for it to be complete. <br />Michael B. Lond <br />Division DlleaOr <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision <br />submittal date should be printed in the Tower right corner of each revision page. A cover letter to the <br />revision should explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing - <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the. review process.must <br />_ be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted _._:...... <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office <br />(AF01, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />Permit No.: C - ~ L - _Q., 2 2 Date: 1 ~ / _ ~ ~, / 9 _ ~ _ - <br /> <br /> 111~. ~1 e s ~ .~ 3. - 1 ~. ~•--- <br />.Street: _ - ~•~• _ ~ a x - ~ ~ ~ - _ - - - <br />City: ~--9- ~-e- ~ ~- -~- ~- - - - - --- . <br />State: C 0 Zip Code: 8 1 4 ~ . 4 _ - - - - _ '.: <br />Brief Description of Revision: 5_ o 'n e 'r s e 't _ -v- v -m '-e s t i c __ <br /> ~ 3 ~ .~ x-' - S ~- n '' ~T - 1 ~' - - _. <br /> ~ .t ms s - S t .r u c t u r e <br />Public Notice Attached:..Yes - No :CX /Required for PRs and TRsI - - <br />r <br />Bond Increase: Yes _ No _,~, Federal X Non-Federal _ 'Mine <br />Proposed Change in: <br />Disturbed Area (+/-) - - 0_ , 0 Acres <br />Permit Area (+/-) - _ ~ . ~„ Acres <br />State Land (+/-) - - Q . _Q Acres <br />m :1 e o al\ a h e r e51 o r m x5886 6 <br />Affected Area (+/-) <br />~ . Q Acres <br />Federal Land (+/-) - - D.. ~ Acres <br />Private Land (+/-) - - r,J_ ..2 Acres <br />lames 5. Lxhhead <br />Esecurive Direnor <br />