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~..:~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Departmem of Natural Resources ~~~~~~~ <br />1313 Sherman St., Room 21 S <br />Denver, Colorado 00203 <br />Phone: (3031866-3567 APPLICATION FORM FOR A REVISION <br />FAX: 1303)832-8106 <br />TO A COAL MINING AND RECLAMATION PERMIT DEPAR'IMFNCOF <br />• NATURAL <br />RESOURCES <br />This form must be completed and submitted with all requests for minor revisions, as defined in goy Rprer <br />Rule 1.04(73), technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined c~r^°r <br />in Rule 1.04(901• All revisions are to address the requirements of Rule 2.08.4. Three (3) copies Iamn S. Lochhead <br />of the revision, including maps, must be submitted in order for it to be complete. °ici""D1e'Or <br />Micl+ael g. Long <br />Division Director <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 lower 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 />(AFO), and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />Permit No.: C - g •~ - ~ ~ ~ Date: 0 ~ /1 1 / ~ ~ v~Q <br />Permittee: Y'` a s t s i d e - C o a i ~- - CE` <br />RS p ~ 3 1995 <br />Street: ~, 0 <br />P. 0. 0- <br />- B N. <br />o E. <br />x - L <br />- 1 o o~- <br />~ 4 8 ~ 4 <br />- 1 <br />- 0 <br />- alyi;~eo\o9Y <br />pivislo~ °\ Ml~z <br />city: r~3_ 3L_- ~ rL_ ~~ iLi o - - - - <br />State: ~ x Zip Code: Z 8 2 1 ~ - - - - - <br />Brief Description of Revision: ~ r o 0 o s e d - s o i 1 - - <br /> a <br />- m e <br />- - n d m e <br />- - - - n <br />- t <br />- s <br />- f o r <br />- - - - <br /> ~ ~ s` L ~ 1>L ~ t .~ o n - - - <br />Public Notice Attache d: Yes - No R (Required for PRs and TRsI <br />Bond Increase: Yes No X Federal Non-Federal X Min e <br />Proposed Change in: <br />Disturbed Area (+/-) 0 0 Acres <br />Permit Area (+/-) - - ~ . 2 Acres <br />State Land (+/-) _ - 0 0 Acres <br />m: \w el\s here\f o rm s\8885 <br />Affected Area (+/-) - - 0 . 0 Acres <br />Federal Land (+/-) - - 0 . 0 Acres <br />Private Land (+/-) - - ~ ~ Acres <br />