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<br /> <br /> <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />()epanmenl of Natural Resources ?ir ;~~y,~v~nj~~,rya:Ei <br />I ] 1 ]Sherman SL. Room 215 s~ j <br />Omver. Colorado Solo] DC(`(=~VEp `$ <br />Phorse: 17011 966] 56i ~y <br />FAX: 170]18]29106 APPLICATION FORM FOR A R$~Sly~ ~pqfi ' <br />TO A COAL MINING AND RECLAMATION P@ER'I(AI7 <br />Dlvit3iph of Minerals & Geology <br />This form must be compbted and submitted with all requests for minor revisions, as defined in <br />Rule 1.041731, technical revisions, ea defined in Rule 1.041138), end permit revisions, as defined <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08.4. Three 131 copies <br />o} the revision, including maps, must be submitted in order for it to be complete. <br />Roy Romer <br />Garerrsor <br />4mes 5. Lochhead <br />EsKlmlYe Director <br />ntrchael B Lonq <br />Drvrs~on Dueaor <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 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 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. 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 decision must be submitted to the OSM Western Regional <br />Coordinating Center (1999 Broadway Blvd., Suite 3320, Denver, CO 80202-57331, and proof of submittal <br />to OSM must be submitted to the Division prior to implementation of the revision. <br />Permk No. <br />Permittee: <br />Street: <br />C-~ 0- 0 0 3 Date: 0 7/ 1 2/ 9 6 <br />H-G C O A L C O M P A N Y <br />- - - - - - - - - - - - - - - <br />~ BL E_ - S ~ Jal. ~ _ ~ ~ ~ .S ~ ~ <br />R O A D <br />City: ~ ~ ~, ~ _ ~ A T O N _ _ _ _ _ <br />State: F L Zip Code: 3 3 4 8 6_ <br />Brief Description of Revision: p~1Q~Ir~B~RiN.C=PAIa_,^,pJ.7•L1JA [~ _ _ _ _ <br />STRUCTURE MODIFICATION _ _ _ _ _ _ <br />Public Notice Attached: Yes x No _ (Required for PRs and TRsI <br />Bond Increase: Yes _ No ~( Federal _ Non-Federal X Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ U . 0 Acres <br />Permit Area 1+/-) _ _ ~ ~ Acres <br />State Land (+/-1 _ _ 0 0 Acres <br />m:\coal\sharelforms\8865 <br />Affected Area (+/-) _ _ ~ .~ Acres <br />Federal Land (+/-) _ _ ~ ~ Acres <br />Private Land I+/-) _ _ 0.0 Acres <br />