REV05040

• Permit No: C1981012
• IBM Index Class Name: Revision
• Doc Date: 10/5/1993
• Doc Name: APPLICATION FORM FOR A REVISION TO A COAL MINING & RECLAMATION PERMIT
• Type & Sequence: TR31
• Media Type: D
• Archive: No

STATE 01= COLOI III iillllllllliiill
-~
Roy Romer. Governor

DEPARTMENT OF NATURAL RESOURCES ~ ~~'
~,~ .
MINED LAYVD RECLAMATION DIVISION ,.1~~''
FRED R. OAHTA, olrector APPLICATION FORH FORA REVISION ^~ ~ ~ ~'
TO A COAL MI NI N6 AND RECLAMATION PERMIT ~-•~
Tnis form must be completed and submitted with all requests for minor revisions, as Refined
in Rule ],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 ?ule 2.08.4.
rnree copies of your revision inciuding maps must be submitted in order for it to be complete.
All revisions are to be formatted 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 beinc
revised. The revision date should be printed in the lower right corner of the revision
^ages. If necessary, the Table Of Contents should also be revised. ~dhen the fi^al version
of Lhe revision is approved, 7 copies must be sent to OSti in Denver for Federal mines and `,-
non-Federal mines 7 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310,
Al Duquerque, New t•texico 81102. fie revision may not proceed until OSM has Deen provided
copies, Copies should be sent certified mail. ,
Date: L a/ a r/~ 3
Permittee: ,~ ~ S ~, ~ - ~ ~ ~, U ~ ~ ~ ~,.~ CCT 5 199,E
~_.~~/L=---------

State: ~ Q ZiD Code: ~ ~ ~ ~ L - - - -
~4ine Name: ~~1~-~~~-,.------- ---
is ox o e t e to y e tvtston:
Type of Revision: _~ (PR, 7R, or MR)
Revision Dlumber: (Sequentia] Dy Revision Type)
Rev, y~dnittal Date: _ _/_ _/_ _ (Date Received by Division) _
Rev, Completeness Date:.- -/- -/- - Rev. Incompleteness Date: - -/- _/- -
Rev, Adequacy Due Date: - -/- -/- - Rev, Adequacy Date: - -/- -/ -
Rev, Decision Oue Oate: - -/ -/ _ Lead Reclamation Specialist: _ -
rte escrtp ton o evtston: S ~ Q _,~ ~ ~ ~ ~ ~ ~ „ -
1~~~,Y ~~~~G
Public Plotice Attached - Yes o (Requtr or R s ~-TR s)
Bond Increase: Yes ~ tlo -Federal Non-Federal t•?ine
proposed Change in: •
sturbed Area (+/-) a.- Acres Affected Area (+/_) Acres
rermit Area (+/-) _ Q.- Acres Federal Land (+/_) - - - - Acres
State Land (+/_) - _ Acres Private Land (+/-) _- _- _- Acres
6185E (Rev. 10/88)
2 t S Centennial Building, t3t3 Sherman Street Denver, Coloratlo 802032273 Tel. [phone]