REV05010

• Permit No: C1981012
• IBM Index Class Name: Revision
• Doc Date: 1/27/1989
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT
• Type & Sequence: MR18
• Media Type: D
• Archive: No

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STATE OF COLORADO
Roy Romer, Gove
DEPARTMENT OF NATURAL RESOURCES
MINED LAND RECLAMATION DIVISION
FRED R. BAN7A, Director
APPLICATION FORM FOR A REVISION
TO A COAL MINING AND RECLAMATION PERMIT
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This form must be completed and submitted with all requests for minor revisions, as defined
in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as
_ -' defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4.
Three copies of your revision including maps must be submitted in order for it to be complete.
All revisicns are to be fcrnatted so they can be inserted into the permit to replace the
revised sections, maps, tables and/or figures. Explain in the revision what section is being
revised. The revision date should be printed in the lower right corner of the revision
pages. If necessary, the Table of Contents should also be revised. When the final version
of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for
non-Federal mines 1 copy must be sent to 05M at 625 Silver Avenue, SW, Suite 310,
Albuquerque, New Mexico 87102. The revision mdy not proceed until OSM has been provided
copies. Copies should be sent certified mail.
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Pertnittee: w ~ .~= 1 ~ ~ - Fy S. 1. - - - ~„~;~:;^ c°
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Street: 1~1-~~is~-BL~d- `,~~' .~~-~ a!'-.
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City: L a 1~~ ~ o o ~---------,~,'_~-
State: C 4 Zip Code: ~ 0 2 ~ 5. - - - - -
Permit No.: C - ~ 1 - 0 1 ~
is ox to e i e to y e Division:
Type of Revision: ~ Q (PR, TR, or MR)
Revision Number ~ ~ (Sequential by Revision Type)
Revision Submittal Date L/~/~j (Date Received by Division)
Revision Completeness Date`/1/~~ Revision Incompleteness Date -/-/-
Revision Adequacy Due Date _/_/_ Revision Adequacy Date _/_/_
Revision Decision Due Date '~ /~l/$°~ Fee b0.00
Brief Description of Revision: ~ m ~ ~ L - e ~ se ~ - - _ - -
G x c s~ $ 's ~ _ _ _
Public Notice At`~ached -Yes ~Jo xx --(Required for~R s and~'R s)
Bond Increase: Yes No ~~ ~deral ~ Non-Federal Mine
Proposed Change in:
Disturbed Area (+/_) p , O Acres Affected Area (+/-) - 12, p Acres
Permit Area (+/-) - _ ~, p Acres Federal Land (+/-) -_ - p Acres
State Land (+/-) - ~ Acres Private Land (+/-) _ p Acres
Lead Reclamation Specialist _ _ _ 6185E (Rev 2]88)
423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203-2273 Tel. [phone]