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May O5 98 09:40a STATE OF p.3 DIVISION OF MINERALS ANO GEOLOGY Dewnmem of Nawral ReSOUn:eS 1313 Sherman SI.. Room 2I S Denver. Colorado 80201 Phone: i10318G6-3567 FAx:~lollalz-alo6 APPLICATION FORM FOR A REVISION TO A COAL MINING AND RECLAMATION PERMIT NATURAL RESOURCE This form must be completed and submitted with all requests for minor revisions, as defined in Ror Raney Rule 1.04(73), technical revisions, as defined in Rule 1.04(1361, and permit revisions, as defined r'pYCA1Of iR Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. Three 13) copies unk', s. luchhe,d t:ecume oirenor of the revision, including maps, must be submitted in order for it to be complete. ,~IiahiN 8. font Oivmon Ovecrw 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 contents, if necessary. The revision submittal date should be printed in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the revision and reference the specific permit sections heing revised. For federal mines, a copy of the revision applicadon must be submitted to all agencies on the federal mailing list at the same time the application is submitted to the Division, and proof of distriburion 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•Tederal mines, a copy of the application for which the Division has issued a proposed approval decision must ba submitted to the OSM Western Regional Coordinating Center 11999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal to OSM must be submitted to the Division prior to implementation of the revision. Permit No.: C- 9 2 0 5 6 Date: Q~ 1 0 4 1~ 8 Permittee: ~ ~ E ~ 1 Y M I L ~ _ _ - - - _ ~ C O ~_ L- C ~_ ~~ P A N Y-_- Street: ~~~ 1~ R ~_ U T T- C O U ~ T Y City: O ~_ ~_-.~ ~~ E K ----- - State: C O Zip Code: ~ _0 ~, ~ 1 - - - Brief Description of Revision: Adrii Linn of AchIP~C rF1CIrTP nfP AgrPP mcnTC Tn rPrmiT Public Notice Attached: Yes _ No X (Required for PRs and TRs) Bond Increase: Yes _ Nom Federal Non-Federal -Mine Proposed Change in: Disturbed Area (+1-) _ _ 0 0 Acres Permit Area (+l-) _ _ Q . ~ Acres State Land (+l-) - _ 0 ~ Acres Affected Area (+/-) - _ ~ ~ Acres Federal Land (+/-) - - ~ ~ Acres Private Land (+1-) - - ~ Q Acres