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<br />STATE OF <br />,~~_. <br />DIVISION OF MINERALS AND GEOLOGY <br />[)cPartmmt of Natural Resources JUL O 1 <br />1717 Sherman St.. Room 215 <br />(krrver. Colorado 80201 <br />Panne: tlon ar>t.-~s67 Division of Minerat <br />FAx:t7o71s1z-aloe APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMR <br />This form must be completed and submitted with all requests for minor revisions, as defined in Roraome. <br />Rule 1.04(731, technical revisions, as defined in Rule 1.041136), and permit revisions, as defined c°°°~ <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4, Three (31 copies -"'R's• tndd,e,d <br />of the revision, inGuding maps, must be submitted in order far it to ha complete. E""11O1ne o1ROOf <br />Micliad a. Lnnq <br />Oivnian Oincmr <br />All revisions are to 6e formatted so they can be inserted irtto the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal <br />date should be printed in the lower right corner of each revision page. A cover letter to the revision should <br />explain the nature of the revision and reference the spedfic permit sections being revised. <br />For federal mines, a copy of the revision application must ba submitted to all agencies on the federal mailing <br />list at the same time the application is submitted to the Division, and proof of distribution must be submitted <br />to the Division along with the application. Copies of revision pages modified during the review process must <br />be distributed in the same manner, along with prcof of distribution. Proof of distribution must be submitted <br />prior to implementation of the revision. For non-federal mines, a copy of the application for which the <br />Division has issued a proposed approval det~sion must he suhmitted to the OSM Western Regional <br />Coordinating Center (1999 Broadway Blvd., Suite 3320, Oenver, CO 80202-57331, and proof of submittal <br />to OSM must be submitted to the Division prior to implementaticn of the revision. <br />Permit No.: C - __@_ ~ - ~ ~. ~ Date:. ~ 1 ~ ~, ! g, _.9_ <br />Permittee: T W E ~ ~ ~ ~ L J.~ ~ <br />~. Q ~ ~ - ~ ~ 1~ ~..A_ t,L ai-. - -- - <br />Street: 1. 9- ~ ~ ~ ,_ g ~. 1L L'L -C~_Ll ~I s Y <br />~SZ ~IZ- ps i-------- <br />city: Q~ ~-~ A~ J-IC-------- <br />State: ~ Q. Zip Code: ~ ~ ~ ~ L - - - - - <br />Brief Description of Revision: TR 99-33 -FACE EXTENSION 2R b 3R. GATEROAD 11 E 12 <br />D V OPMFNT SURFACE FACE MODIFICATION £ IN ID NTAL <br />PERMIT BOUNDARY CHANGE <br />Public Notice Attached: Yes X No- (Required for PRs and TRs) <br />Bond Increase: Yes _ Nom Federel~ Non-Federal -Mine <br />Proposed Change in: <br />Disturbed Area (+1-) _ - Q . Q Acres Affected Area (+l-) ~ ~ ~ . ~ Acres <br />Permit Area (+l-) _ - Z . Z Acres Federal Land (+l-) ~ ~ ~ . ~ Acres <br />State Land (+l-) 1 ~, Z . ~ Acres Private Land (+/_) - ~ ~ , L Acres <br />