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~.m, <br />~II ~~~~I~~II~~~~ ~I~ <br />sss <br />-~.~- <br />COLORADO DIVISION OF MINERALS AND GEOLOGY <br />1313 Sherman Street, Room 215, Deover, Colorado r~ <br />auc 4 ~ <br />APPLICATION FORM FOR A REVISI N <br />TO A COAL MINING AND RECLAMATION ER <br />IV. OF MINERALS <br />I 8 GEOLOGY <br />This form must be completed and submitted with all requests for minor revisions, as defined in Rule <br />1.041731, technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.041901. <br />All revisions are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including <br />maps, must be submitted in order for it to be complete. <br />All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, <br />maps, tables and/or figures, with a revised table of contents, if necessary. The revision submittal date <br />should be printed in the lower right corner of each revision page. A cover letter to the revision should explain <br />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 (except OSM) at the same time the application is submitted to the Division, and proof of distribution must <br />be submitted to the Division along with the application. Copies of revision pages modified during the review <br />process must be distributed in the same manner, along with proof of distribution. Proof of distribution must <br />be submitted prior to implementation of the revision. <br />Permit No.: C - ~' 1 - O 1 'Z Date: ~ / ~ / <br />Permittee: P~clw.+w:~._ P.-,~«rr~,1~ L~-c <br />Street: ~:-F~e t2lo <br />City: Qz,., ~ c r <br />State: Gd Zip Code: $ ~ Z 37 - <br />Brief Description of Revision: ~ 1 rn w!e /4-n 1.a Co,, ~, Sk,.F-E-s <br />Public Notice Attached: Yes _ No ~ (Required for PRs and TRsI <br />Bond Increase: Yes _ No ~ Federal _ Non-Federal ~C Mine <br />Proposed Change in: <br />Disturbed Area (+/-) _ _ ~ . _ Acres <br />Permit Area (+/-) _ _ Q . _ Acres <br />State Land (+/-) _ _ fZ . _ Acres <br />Affected Area (+/-1 _ _ Q. _ Acres <br />Federal Land (+/-) _ _ U • _ Acres <br />Private Land (+/-) _ _ O . _ Acres <br />m: \co al\s h a re\f orms\8865 <br />