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• • 1111111111111111111 <br />STATE OF COLUIV~U <br />DIVISION OF MINERALS AND GEOLOGY <br />Drpartmenl of NaWral Rewurres _ _ 11 f <br />171 f Sherman $r .Roan 215 .-t ~ ' ~ ` F I r\/ C [I <br />Den.er, Colorado 8070) <br />Phonc' 1707) 666-7567 APPLICATION FORM FOR A REVISION APR 2 ~ i995 <br />F AJ(. 1)071 872-6106 <br />TO A COAL MINING AND RECLAMATION PERMIT <br />Divistol~ ur r~~r~e~ais x ~eolc9l <br />Thrs 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(136), and permit revisions. as defined ~""r <br />in Rule 1.041901. All revisions are to address the requirements of Rule 2.08-4. Three (31 copies HTa s. lnchheaa <br />of the revision, including maps, must be submitted in order for it to be complete. t"O1~ar"Of <br />.nkisxt 6. u» <br />DMwm O~reoor <br />All revisions are to be formatted so they tan be inserted into the permit to replage the revised <br />sections, maps, tables and/or figures, with a revised table of contents, rf necessarv• The revision <br />submittal date should be printed in the lower right corner of each revision papa. A cover lerter 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 t0 all agencies On the federal mailing <br />list at the same time trte 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 dismbumon. 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 submittetl to the Division prior to implementation of the <br />revision. <br />Perrttit No.: C - ~ ~ - ~ Z 3 Date: 0 ~ / Z 'i 1 ~ ~ <br />Permittee: ~ ~c ~ 5 ~ r _ ~ g ~ v ~ r'~ ~ S7 <br />= n c <br />- - - - - - - - - - - - - - - <br /> - - - - - - - - - - - - - - - <br />State: ~ ~ Zip Code: ~ ~ Z ~ ~ - <br />Brief Description of Revision: ~ ~ ~ r ~ £ _ ~ n -~ ~ ~ ~ _ <br />a ~- ~ e- -~--5- ~ ------ <br />Public Notice Attached: Yes _ No ~( /RequJied for PRs and TRsJ <br />Bond Increase: Ves _ No ~ Federal ~ Non-Federal _ Mine <br />Proposed Change in: <br />Disturbed Area (+1~1 _ ~ . _ Acres <br />Permit Area (+ /-) _ _ O . _ Acres <br />State land (+l-) _ _ D . _ Acres <br />Affected Area (+/-1 _ _ O . _ Acres <br />Federal Land (+/-) _ _ ~ _ Acres <br />Private Land (+/-) ~ Acres <br />m: \eod\sh eret to r ms\8865 <br />