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III1111111111111111 STATE OF COLORADO <br />•`.^ ~ ~~• Roy Romer. Governor <br />~ ~ •~~~~• <br />,~, - <br />DEPARTMENT OF NATURAL RESOURCES ~ ~~ <br />~, <br />MINED LAND RECLAMATION DIVISION rYl~~ <br />• ~ . , ,•: <br />F11ED A. BANTA, Dlnctor ~'•~ •~ ~' <br />APPLICATION FORH FOR A REVISION r ~~ <br />70 A tOAi MINING AND RECLAM47ION PERHI7 <br />This forth must be Completed and submltted with all requests for minor revisions, as define <br />in Rule 1.04(73), technical revisions as defined in Pule 1.04(36) and permit revisions, as <br />defined in Rule 1,04(90). All revisions are to address the requirements of ?uie 2.08.4• <br />Three copies of your revision including maps must De submitted in order for it to be complete. <br />All revisions are Lo be formatted So they can be inserted into the permit tD replace the <br />revised Sections, maps, tables and/or figures. Explain in the revision what section is Dein; <br />revised. The revision date should be printed in the lower right corner of the revision <br />gages. If necessary, the Table of Contents should also be revised, ~dhen the fi.^.at version <br />of :he revision is approved, 7 copies must be sent to OSH in Denver for Federal mines am °~• <br />non-Federa] mines 1 copy muss be sent to OSM ai 625 Silver Avenue, Su, Suite 310, <br />Albuquerque, New T•texico 87102, The revision may not proceed until OSM has been provided <br />copies. Copies snou]d be sent certified mail, <br />Date: L/ - ~/ s ~/ <br />?ermittee: g i4 s r ~- LZ C- S U v 2 C C S <br />,creel: 1 ~(3 ~ o - />` / G ~{ ~.^r_ - /Z <br />Ltty: li~L=s Tc~ Wit/-------------__~E-~IU~C <br />State: ~v zip code: _ - - - - - - - - - !4iq~ p3 1934 <br />?ermi t plo. C-~ (- a L Z <br />Mine Name: JU ~i L~J- ~ L' 1C- - - - - - - - - - ~ ~ P,i~nerr~ ~.~c:. <br />~nis oox to oe rr++ea rn oy the olvrsion: <br />Type of Revision: ~ iZ (PR, TR, or h6t ) <br />Revision plumber: - - (Sequential by Revision Type) <br />Rev. Submittal Date: _ _/_ /_ _ (Date Received by Division) <br />Rev. Comp? eteness Date: - ~/ _/- - Rev. Incompleteness Date: - -/_ -/- - <br />Rev. Adequacy Oue Date: - _/- _/ - Rev, Adequacy Date: - -/- _/ - <br />Rev. Decision Due Date: _ -/- -/_ _ Lead Reclamation Specialist: - - <br />rie escrip ton o evrsron: L~ ` ~_ - i~ s ~ _ ~,.~..! <br />Pub1 i c ploti ce Attached - Yes - '-Ao~ (tfequT rea ~r~R s and-TR s) - <br />Bond Increase: Yes Ito _ federal Non-Federal p?ine <br />Proposed Change in: <br />sturbed Area (+/_} Acres Affected Area (+/-) Acres <br />rermi t Area (+/_) - - '"',- Acres Federal Land (+/-) -' - - -Acres <br />State Land (+/-) - - <br />~" - -Acres Drivate Land (+/_) - ` Acres <br />6185E (Rev. 10/88) - _ <br />- - - <br />275 Centennial Builtlinp, 1373 Sherman Street Denver, Co+oratlo 80203.2273 Te1.1303) 8663567 <br />