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pichartl D. Lamm <br />Governor <br /> <br />• ~II ~I~~I~~I~~~~~ ~~~ <br />999 <br />DEPARTMENT OF NATURAL RESOURCES <br />DaWtl H. Getcnee. E.ecutiva Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SHELTO N, Director <br />APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as <br />defined in Rule 1.04(73), technical revisions as defined in Pule 1.04(36) and permit <br />revisions, as defined in Rule 1.04(90), All revisions are to address the requirements <br />of Rule 2,08.4. <br />?bs <br />All revisions are to be formatted so they can be inserted into the permit to rep~ace the <br />revised sections, maps, tables and/or figures. Explain in the revision what section is <br />being revised. The revision date should be printed in the lower right corner of the <br />revision pages. If necessary, the Table of Contents should also be revised. <br />Date: 0 8/ 0 7/ 9 0 <br />Permittee: T P. A P = F R _ M I ~ L I~ ~ - <br /> _ _ `."~ r-- <br />- <br />=" <br />--- ~~' <br /> I Pd C ____________ ~ <br />_ <br />- <br />1 <br />Street: P -o s ~~x-~~.~----- r1IJG y 01`?~' <br /> <br />C1ty: - <br />C -- <br />R A ------------ <br />I G <br />;~:i;.._~ ~~-.ra- <br />- <br /> - -- ------------ -- -.. . <br />;n, r,: ,. <br />State: c o Zip Code: 8 1 6 2 6-____ <br />Permit No C - 8 1- 0 1 0 <br />This box to be filled in by the Division: <br />Type of Revision: _ _ (PR, TR, or MR) <br />Revision Number _ _ (Sequential by Revision Type) <br />Revision Submittal Date _/_/_ (Date Received by Division) <br />Pevision Completeness Date _/ / Revision Incompleteness Date _/ / <br />Revision Adequacy Due Date -/ / Revision Adequacy Date -/-/ <br />Revision Decision Due Date / / Fee E0,00 <br />Brief Description of Revision: s_ U_ I_ T_ A B L E _rt A z E R I A L s <br />A <br />- B A N <br />--- D 0 ;7 E D <br />----- D P. I L L <br />------ H 0 L E s <br />-- <br />Public Notice Attached - Yes _ No Y (Required for PR's and TR's) <br />Bond Increase: Yes _ No x <br />Proposed Change in: <br />Disturbed Area (+/-) 0 0 Acres Affected Area (+/-) _ _ _ _ Acres <br />Permit Area (+/-) _ _ o_, 0 Acres Federal Land (+/-) _ _ <br />- P.cres <br />State Land (+/-) Acres Private Land (+/-) Acres <br />Lead Reclamation Specialist D A B 6185E <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. {3031 8o8.35E7 <br />