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STATE OF COLORADO DIVISION OF MINERALS AND GEOLOGY Department of Nawral Resources 1713 Shaman St., Room 215 Demrr, Colorado 80203 Phone 13031 D66~3567 RECEIVED JAN 0 3 1995 fAx: fa071 832-8106 APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATI~WIWf~RAhURlerals & Geology ~~'- y~~ DGI'AI':fMGNT OF NA rUl~ RL-'SOLJ]ZCE~ This form must be completed and submitted with all requests for minor revisions, as defined in Rny Ro,,,,_, Rule 1.04(731, technical revisions, as defined in Rule 1.04136), and permit revisions, as defined cove~no~ in Rule 1.04190). All revisions are to address the requirements of Rule 2.08.4. Three 13) copies lamas s t„~nne,~d of the revision, including maps, must be submitted in order for it to be complete. t>,ec°'i" D"""" Michael P Long Division Ui~eam All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Albuquerque Field Office (AFO), and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. Permit No.: C/-f O I - d ~ Y Date: ~ 'L / Permittee: Ptji2iR~~K Cow- C'o,wAA-mac - - - C/6 L7bvD.i^A~I2K IQ~}C~ hvr+F4~T O~ ~L Street: 2150 f S l~I,AJ~ rR Nor=~>= City: L tir t S t~~ - State: ~C7 Zip Code: Brief Description of Revision: ~ 9/~'y ~I~D /-~------ /~/%1~~Krrrrtfi" Or c.r.~y, ~/+~$ ~3/i5fa,[! - - - - - - - - - - - - - - Pubiic Notice Attached: Yes - No f~ (Required for PRs and TRsI Bond Increase: Yes - No ~ Federal - Non-Federal ~ Mine Proposed Change in: ~~ Disturbed Area (+/-) - - - -Acres Affected Area 1+/-) - - - _ Acres Permit Area (+/-) - - - -Acres Federal Land (+/-) - - - -Acres State Land (+/-) - - - -Acres Private Land (+/-1 - - - -Acres m: \uo el\s h are\fo rms\886 5