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... ,., <br />STATE of co~o~oo <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmens of Nmural Resources <br />7 7 7 3 Sherman St ,Room 2 7 5 <br />Denier, col«ado eoto3 <br />Phone l70)7 866-3567 APPLICATION FORM FOR A REVISION <br />rAX. U03) 833-8706 <br />TO A COAL MINING AND RECLAMgTION PERMfE <br />This form must be completed and submitted with all requests for minor revisions, as defined in ~ ~„ <br />Rule 7.04(73), technical revisions, as defined in Rule 1.0411361, and permit revisions. as defined ~"« <br />in Rule 1.04(901. All revisions are to atldress the requirements of Rule 2.08.4. Three l3i copies )amps. Lxhhead <br />of the revision, including maps, must be submitted in order for it to be complete. [.-., pre Dlrecmr <br />Michael 6. ~u.6 <br />D,risiorr D:.Ma <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, finecessary. 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 proai 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 he submitted to the OSM Albuquerque Field Office <br />(AFO), and proof of submittal to AFO must be submitted to the bivision prior to implementation of the <br />revision. <br />Gu~v/a~o Gohl Nt:ne Nd. ~ <br />Permit No.: C - $ ~ - O 'Z ~ Data: ~ (o- l 3 O / ~ S <br />Permittee: ~ ~ i 5 2 r - ~ Q ~ ~ ~ ~ ~ e S <br /> ~ <br /> ~ `' - - -- - - - --- - RECEIVED <br />street: ? _ Q - - 3 ~ ~ ~ 3- - - - - <br /> _ - _ JUL 0 3 1995 <br />City. ~ 2 ~ _Q r ± - G e n t ~ !- - - p;vision of Minerals & Geology <br />State: G ~_ Zip Code: g Z L ~ q - _ _ - - <br />Brief Description of Revision: C ~ r ~ ~ ~ a ~ e _. ~ ~ v!c e <br /> c- h ~ ~ ~ 3. ._._ - - - - - - ---- <br />Public Notice Attached: Yes _ No ~ /Required for PRS and TRsI <br />Bond Increase: Yes _ No ~ Federal - Non-Federal ~ Mine <br />Proposed Change in: <br />Disturbed Area 1 + /-) - ~ . -Acres Affected Area l + /-1 - _ ~ . _ Acres <br />Permit Area I +/-) - - O _ Acres Federal Land (+/) _ _ O . _ Acres <br />State Land (+/-) _ - ~ . -Acres Private Land (+/-1 _ - _~ _ Acres <br />m: \coel\s h erel fo rms\6865 <br />