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.~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1) I) Sherman $1., Room 21 5 <br />Denver, Colorado 80207 <br />Phone: (7031 866-]567 <br />FA%: (7071872-8106 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined in <br />Rule 1.04(731, technical revisions, as defined in Rule 1.04(36), and permit revisions, as defined <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three (31 copies <br />of the revision, including maps, must be submitted in order for it to be complete. <br />~~~~ <br />DEPARTMENTI <br />NATURA <br />RESOURCl <br />Roy Romer <br />Governor <br />lamer 5. Lochhead <br />EiKUlive DireCYOr <br />Michael ~8. Long <br />Division Di•~+~• <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables and/or figures, with a revised table of contents, if necessary. The revision <br />submittal date should be printed in the lower right corner of each revision page. A cover letter to the <br />revision should explain the nature of the revision and reference the specific permit sections being revised. <br />For federal mines, a copy of the revision application must be 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 proof of distribution. Preof 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 decision must be submitted to the OSM Albuquerque Field Office <br />(AF01, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />Permit No.: C -. e i - o z g~ Oate: ~ ~ / ~ ~ / ~ i <br />Permittee: T' R. n_. p_P E R M i rr r N c~ i. t~~c-RFCEIV~I~ _ <br />Street: P o-B o`x-i 8 ~-----_-AUG281995 <br />- - - - - - - - - - - - - Divl`slon of Mlnelais 8 Geology <br />State: y ` Zlp Code: 8 1 6 2 5 - _ _ - - - <br />Brief Description of Revision: g, bra ~ ~ ~ 'LI_D ~L -o~ - - - <br />A P I T L A ~I D S L I D E - <br />Public Notice Attached: Yes x No _ (Required for PRs and TRsI <br />Bond Increase: Yes _ No x Federal x Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ - _ _ Acres <br />Permit Area (+/-) _ - - _ Acres <br />State Land 1+/-) _ - - _ Acres <br />m: \co ells h arel fo rm s\886 5 <br />Affected Area (+/-) - - _ -Acres <br />Federal Land (+/-) _ - _ _ Acres <br />Private Land (+/-) - - - _ Acres <br />