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• • <br />.~~~ STATE OF COLORADO <br />Roy Romer, Govei <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION DIVISION <br />FRED R. BANTA, Dlr~etor APPLICATION FORM FOR A REVISION <br />TO A COAL MINING AND RECLAMATION PERMIT <br />This form must be completed and submitted with all requests for minor revisions, as defined <br />in Rule 1.04(73), technical revisions as defined in Rule 1.04(36) and permit revisions, as <br />defined in Rule 1.04(90). All revisions are to address the requirements of Rule 2.08.4. <br />Three copies of your revision including 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 <br />revised sections, maps, tables and/or figures. Explain in the revision what section is being <br />revised. The revision date should be printed in the lower right corner of the revision <br />pages. If necessary, the Table of Contents should also be revised. When the final version <br />of the revision is approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br />non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite 310, <br />Albuquerque, New Mexico 87102. The revision may not proceed until OSM has been provided <br />copies. Copies should be sent certified mail. <br />Date: U N/13/g~ <br />Permittee: S ~ v R G 0- G o$~_--- <br />- - - - - - - - - - - - - - - <br />street: B Q ~ - z ~s 1 ~ ~ g - - - - - RECEIVFn <br />- APR 1 ~ 1994 <br />city: ~~~~ w o o ~------------ <br />State: ~ O Zi p Code: ~ Q 2 Z S - ~ ~ O ~ Ci~ °~~~~ ~~ ~,,,;,`r~:; ,_ `" ` <br />Permit No.: C-~ 1- O Z 6 ~~ <br />t4ineName: GgL~~~11~LJ- 5 S.1il~------ <br />s ox o i e in y e ivtston: <br />Type of Revision: ~ ~ (PR, TR, or MR) <br />Revision Number: D '1 (Sequential by Revision Type) <br />Rev. Submittal Date _ _/_ _/_ _ (Date Received by Division) <br />Rev. Completeness Date: - -/- -/- - Rev. Incompleteness Date: - -/- -/- - <br />Rev. Adequacy Due Date: - -/- -/- - Rev. Adequacy Date: - -/- -/- - <br />Rev. Decision Due Date: - -/ -/ - Lead Reclamation Specialist: - - - <br />rte escr p ion o eves on: .g L L ~ - gL! 8 - ~ U ~ ,~ E ~ <br />Public Notice Attached - Yes o x equire ~r Res and'-TR s) <br />Bond Increase: Yes No _~ a eral -~ Non-Federal Mine <br />Proposed Change in: <br />Disturbed Area (+/-) p . Acres Affected Area (+/-) O . Acres <br />Permit Area (+/-) - - Q,_ Acres Federal Land (+/-) - - p - Acres <br />State Land (+/_) _ = Q Acres Private Land (+/-) _ = p Acres <br />6185E (Rev. 10/88) <br />215 Centennial Building, 1373 Sherman Street Denver, Colorado 80203-2273 Tel. (303) 866-3567 <br />