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7 <br /> <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Oepanmenl of Natural Resources <br />RECEIVED <br />IJIJSherman St., Room 215 <br /> <br />Denver, Colorado 80201 <br />Phone: 17071844-)347 ~ MAY 1 ~~~ <br />1 1995 <br />FA%:170)1072-8104 APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMfT DEPARTMENC OF <br />Division of Minerals ~, Geolo gy NA'I'LJRAL <br /> RESOURCE <br />This form must be completed and submitted with all requests far minor revisions, as defined in Roy Romer <br />Rule 7.04173), technical revisions, as defined in Rule 7.04(361, and permit revisions, as defined c°`e'nO' <br />in Rule 1.04(901. All revisions are to address the requirements of Rule 2.08.4. Three 13) copies I+~ s. Lo<nhe,d <br />of the revision, including maps, must be submitted in order for it to be complete. r""Y1rveD11e"°' <br /> Michel 8. Lang <br /> <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised Division Dir¢clor <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 let ter 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. 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 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- 6 4- 0 6 5 Date: 0 5 /0 3/ 9 5 <br />Pcrntitlec: N C I G_ F I N AN C I A L,L_ I N C ________ <br />C O A L_ R I D G E_ N O_ 1 M I N E <br />Slrect: P O _ H O X 9 2 4 0 1 <br />- - - = - - - - - - - - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - - - - - - - - - - - - - - <br />City: L O S _ A N G E L E S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />State: C A ZipCodc: 9 0 0 0 9- ______________ <br />Brief Descripliott of Revision: C H A N G E_ R E S I D E N T_ A G E N T <br />Public Notice Allaclted; Yes _ No XX (Required for PR's ally! TR;s) <br />Bottd Illcreasc: Yes _ No XX Federal _ Nolt-Federal XX Mine <br />Proposed Cltaltge ill: <br />Disturbed Area (+/-) _ _ 0.0 Acres Affected Arca (+/-) _ _ 0.0 Acres <br />Permit Arca (+/-) _ _ 0.0 Acres Federal Lattd (+/-) _ _ 0.0 Acres <br />State Lattd (+/-) _ _ 0,0 Acres Private Lattd (+/-) _ _ 0.0 Acres <br />