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STATE OF COLORADO <br />MINED LAND RECLAMATION DIVISION <br />Department of Natural Resources <br />13t 3 Sherman St.. Room 215 <br />Denver. CO 60203 <br />303 866~36fi7 <br />FA x: 307 832.8706 <br />OF'~~/p <br />0.~ 4 <br />Roy Fame. <br />Governor <br />' Free R. Boma. <br />APPLICATION FORM FOR A REVISION G~vision 0iregor <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with aTl requests for minor <br />revisions, as defined in Rule 1.04(73), technical revisions as defined in <br />Rule 1.04(36) and permit revisions, as defined in Rule 1.04(90). All <br />revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br />your revision including maps must be submitted in order for it to be complete. <br />A11 revisions are to be formatted so they can be inserted into the permit to <br />replace the revised sections, maps, tables and/or figures. Explain in the <br />revision what section is being revised. The revision date should be printed <br />in the lower right corner of the revision pages. If necessary, the Table of <br />Contents should also be revised. When the final version of the revision is <br />approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br />310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br />has been provided copies. Copies should be sent certified mail. <br />Permit No.: C- g,- Q Z 1 ~'ytr-.rte ti ,~~ <br />Date: 0 2 / 2 0 / ~ ~ r; t~~./~~ ~v r~~ <br />Permittee: C O L O S 8. 12 ~_ Y A M P A_ <br />C O A L_ C _O M P A N Y FEB ``~' S )991 <br />Street: z 9 5 7 9_ R O U T T_ _, __ ?Mined i_and <br />c o u N r Y R O A D z ~ Reclamation Division <br />- - - - - - - - - - - - - - - <br />City: O A K _ C R E E K ________•___ <br />State: C _O Zip Code: 8 0 4 6 '7 - ` _ _ _ <br />Mine Name: MINES 11 2,_ E _ E C K M A N _ ~ g ~.~ _ _ <br />Brief Description of Revision: _A N N_U_A L i R E C L A M A T I O N _ <br />R E P O R T S U B M I T T A L <br />- - - - - - - <br />Public Notice Attached - Yes No X (Required for PR's and TR's) <br />Bond Increase: Yes No X Federal X Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _N/A_ ~ Acres Affected Area (+/-) _ N/A` _ Acres <br />Permit Area (+/-) N/A _ _ Acres Federal Land (+/-) N/A_ Acres <br />State land (+/-) N/A Acres Private Land (+/-) a N/A Acres <br />