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` ~ ~ ' _ ~ STATE OF COLORADO DIVISION OF MINERALS ANO GEOLOGY ~ r ~ Depenfnlnl OI Nitufil ResourclS I J I l shemwn st.. Room 71 S R~ r E I V E D (_- Yt DenV!'f. L.OIOIidO e°7°J ~~ Phone; UOJ1 e66.7567 ~G i ~ ~:19U •p; rAx: (Jon eJ7-eta APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PE~tMIT Di~AR11v~SfI' G't Dw~o~on or M nerais t?< Geology NA'j'~A' RESOURCE-:` This form must be completed and submitted with all requests for minor revisions, as defined in Roy Romer Rule 1.04(73), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined ~"1pf in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three (31 copies Wne, s. taJiheee of the revision, including maps, must be submitted in order for it to be complete. r"eCVtlYe °h`°Of Michell 6. t~ Divnien pi,ettsr All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, tables andlor figures, with a revised table of contenu, if necessary. The revision submittal date should be printed in the lower right comer of each revision page. A cover letter to the revision should explain the nature of the revision and reference tfie specific permit sections being revised. Far federal minas, a copy of the revision application must be submitted to all agencies on the tederal 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 ,nust be submitted to the OSM Albuquerque Field Office 1AF01, and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. Permit No.: C- 9 2- 0 8 1 Date: 0_ 8_/ 0 9/ 9 6 Permittee: H A y D E N_ G U L C A _" __ T E R M I~ A L_ I N~___ Street: 1 3 0 0_~ O U T~_ Y A L E City: F L A G~ T A F F _____ State: A 7~ Zip Code: 8 6 0 0 I - _ _ _ _ Brief Description of Revision: R ~ ~ Q S ~ ~ _ P E Q ~ Q T p g~~_ D E S C R I P T I O N Public Notice Attached: Yes _ No ~ fRequiied for PRs and TRs/ Bond Increase: Yes No X Federal _ Non-Federal R Mine Proposed Change in: Disturbed Area t+!-) _ _ 0 0 Acres Affected Area (+/-) _ _ 0 0 Acres Permit Area (+/-) _ _ 0 . Q Acres Federal Land (+/-) _, _ _Q . Q Acres State Land (+/-) _ _ 0 . Q Acres Private Land (+/-) _ _ 0 0 Acres m :1 co a I1 s h e f a 1 f o r m s 188 8 5