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iii iiuiiiiiiiu iii <br />STATE OF COLORADO <br /> <br />Hoy Aomar. Oovarnor <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAYV D RECLAMATION DIVISION <br />f+11ED 0. sA1RA.04raetw APp1ICATION FOAM FOR A REVISION <br />TD A CARL MIIQN6 AIR) RECWNTIOII PERMIT <br />This form oust be capleted and subtaftted Mtth All n0uests for sfnor nrfsions, as deftne4 <br />in Rule 1.04(73), technical recisions as defined in Rule 1.04(76) and persit nrfsions, as <br />defined in Rule 1,04(90). All recisions an to address Lhe require~oents of Rule 2,08.4. <br />Three copies of your recision including saps aa-st Dt suDettted in order for it to De complete. <br />All revisions are t0 Oe fonaatte0 so they can D! inserted into the permit t0 replace Lh! <br />reviseC sections, maps, tables and/or figures, Explain in the revision what section is bein; <br />revised. The revision date should be printed in the lower right corner of the revision <br />gages. If necessary, tree Table of Contents should also be revised. ;then the fi:tal version <br />of Lhe revision is approved,) copies lust De sent to OSM in Denrer for Federal mines air ':r <br />non-Federal mines 1 copy lust be SeM to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, Nex fkxico 81102, The nrlsion say not proceed until OSM nos been provided <br />copies. Lopies should be sent eenifiM sail. <br />;_;. <br />Date: _ ~~/ _ ~/ ~ ~ ,: <br />permtttee: ~~S i N _ ~So_c.~,e~s - <br />- - ;~~n ,~a~, <br />- ------'---- <br />,treet: / ~ 3 D O ~ G/fGU~~-/L <br />Sta :e: ~ (.~ Zip Code: ~ (d ~ / " _ _ - -^ a <br />-_ <br />;4ine lame: G~ L ~C- /~_~~t-G G ~ <br />~ s ox o e i e ~n y e~ son: <br />Type of Revision: ~~ (PR, TR, or fR) <br />Revision Humber: _ _ (Sequential Dy Recision Type) <br />Rev, Submittal Date: _ _/_ _/_ _ (Date Receired by Division) <br />Rev. Completeness Date: / / Rer. Incaapleteness Date: _ _/_ -/_ _ <br />-- - <br />Rev. Adequacy Due Date: / / Rev. Adequacy Date: ` _/, _/ - <br />~_~_ <br />Rev. decision Due Date: _ _/ _/ Lead Reclamation Specialist: <br />._ <br />rie escnp ion o evis~on: Lg-_L _ _~Q, _ _ ~, <br /> __ <br />~v~ ~~~v~ <br />'- <br />Public Notice Attached. - _ <br />TR s) <br />Yes -No ~quin~3 tor~R s and <br /> <br />Bond Increase: Yes ~ Hfn <br />-lo ` ~lrai Non-Federal <br />proposed Change in: <br />iturbed Area (+/-) Acres <br />. <br />Acres Affected Area (./-) <br />re-711it Arta (+/-) - - _ <br />_ <br />Acres <br />' _ -Acres Federal Land (+/-) , ' <br />State Land (+/-) _ _ <br />-Accts Prigte Land (./-) -' ~ _ Acres <br />-' <br />_ <br />6185E (Rev, 10/88) _ _ <br />2 ~ 5 Centennial 8uildinq, t3 t3 Snaem~n St/Nt panrer. Cotorada8020~•2273 Tel.l]071 a66 J567 <br />