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~ _ <br />STATE OF COLO. _ _ 999 <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanment of Natural Resource <br />1317 Sherman 51., Room 215 <br />Denver, Colorado 80203 <br />Phone: (3031866.3567 APPLICATION FORM FOR A REVISION <br />FAX: (3031 832-8106 <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 Roy Romer <br />Rule 1.04(731, technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined eoverror <br />in Rule 1.04(901• All revisions are to address the requirements of Rule 2.08.4. Three 131 copies I+mes s. Locnhead <br />of the revision, including maps, must be submitted in order for it to be complete. Faecurrve D.recta <br />Michael g. Lang <br />Division Duator <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised <br />sections, maps, tables andlor 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. 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 />(AFOI, and proof of submittal to AFO must be submitted to the Division prior to implementation of the <br />revision. <br />7i2-02 <br />Permit No.: C - ~Q - -Q~ _ _ Date: ~3- / ~ _ / -~ <br />Permittee: ~o'¢g2t,~Jeg~_ - - - - - - - _~ - - <br />o. c. code l7iae _ _ - - - - - - _. - ~~('EIVED <br />street: ?us4 c°~,ty i~earl X30- _ - - - - _ - - APR 0 3 1995 <br />- - - - - - - - - - - - - - - <br />City: Gr2niudon - _ _ - - - - - - _ - - Divl;~o~~ ~~ ,.~~~lerals 8 Geology <br />State: Co_ Zip Code:B/?3~ - - - - <br />Brief Description of Revision: ~jtr~dnn}nl~ Po~~ r/rr,nT #~,i.gcp„~jg - - - <br />~p~ox_8.5 acice~ -------- <br />Public Notice Attached: Yes " No _ (Requited for PRs and TRsI <br />Bond Increase: Yes - No ^ Federal ` Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _. __ P•cres Affected Area (-t~/-1 _ <br />Permit Area (+/-- -`- 8 5 Acres Federal Land l * /-1 _ <br />State Land (+/-) _ _ _ ,__ Acres Private Land (+!-) _ _ <br />.:.:Vac: 11sh~roltormclBCftG <br />- Acres <br />- Acres <br />Acres <br />