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sT~T~ of co~o~o DIVISION OF MINERALS AND GEOLOGY oewn~ d wwral Resources RECEIVE J 13 y,en,,,n sr., Rnom Z ~ 5 oEn.er. cdnr~do eo2o7 FEB 2 2 1! vhane. 0071 e66-3567 APPLICATION FORM FOR A REVISION FAX. 1703) 932-8706 TO A COAL MINING AND RECLAMATION ~Eot Ivunerals ~ This form must be completed and submitted with all requests for minor revisions, as defined in ~~ Rules t .Oa(731, technical revisions, as defined in Rule 1.0411361, and permit revisions: as defined ~"a in Rule 1.04(901. All revisions ors to address the requirements of Rule 2.08.4. Three (31 copies y~.srom6s.d of the revision, inducting maps, must be submitted in order for it to be complete. 6evi°1eD"L°r rndrel0.ls{ All revisions are to be formatted so they can be insetted into the permit to replace the revised o,.r+~.o.eow. sections, maps, tables and/or figures, with a revised table of contents, if mscessary. The revision submittal date should be printed in the lower dgM corner of each revision page. A Dover fetter to the . revision should explain the nature Of the revision and reference the specific permit sections being revised. For federal mines, a copy of the revision application must be submitted to all agencies on th9 federal maifutg list at the same time the app/"nation is submitted to the Division, and proof of distribution must be submitted to the Division along with the application. Copies of revision pages modified during the review process must be distributed in the same manner, along with proof of distribution. Proof of drstribution must be submitted prior to implementation of the revision. For non-federal mines, a copy of the application for which the Division has issued a proposed approval decision must be submitted to the OSM Alhuquerque Field Office (AFOt, and proof of submittal to AFO must be submitted to the Division prior to implementation of the revision. Permit No.: C-~ 1- O 2 +j Date: O Z! Z o l d S Permittee: ~ g i ~ ~ r - ~ g ~ sL ~ ~ L ~ 5l Street: ~~ D _-~~~-~Z--__ - - - - - - - - - - - - - - - State: G ~ Zip Cade: ~ ~ Z 3 ~ - _ - - _ Brief Description of Revision: ~ ~ ~ ~ ~ _ ~ g ~L. - ^E- - _ V --~ ~ ~ -r -S'' - - - - - - - - Public Notice AttacAed: Yes - No X lRequ/red !or PRs and TRsJ Bond Increase: Yes - No ZC Federal _ Non-Federal ~C Mine Proposed Change in: Disturbed Area t + /-1 _ - Q . _ Acres Affected Area l +/-1 _ _ O . _ Acres Permit Area (+1-) _ _ O . _ Acres Federal Land l+/-) _ _ O . _ Acres State land (+/-) _ _ d . _ Acres Private Land (+!-) _ _ ~ _ Acres m:\cnd\s~~rNrorms\6aeS